UK Bird Flu News - UK News

Britain closes swine flu hotline

Swine flu drugs service shut down

Swine flu drop sees service close

Protect kids against swine flu, doctors urge

NHS flu line being switched off in sign outbreak is over

BC Centre for Disease Control launches influenza genome sequencing project

Report on response to swine flu

Child swine flu jab scheme starts

Swine flu was as elusive as WMD. The real threat is mad scientist syndrome | Simon Jenkins

Remember the warnings of 65,000 dead? Health chiefs should admit they were wrong – yet again – about a global pandemic

Let me recap. Six months ago I reviewed the latest bit of terrorism to emerge from the government's Cobra bunker, courtesy of Alan Johnson, home secretary. Swine flu was allegedly ravaging the nation. The BBC was intoning nightly statistics on what "could" happen as "the deadly virus" took hold. The chief medical officer, Sir Liam Donaldson, bandied about any figure that came into his head, settling on "65,000 could die", peaking at 350 corpses a day.

Donaldson knew exactly what would happen. The media went berserk. The World Health Organisation declared a "six-level alert" so as to "prepare the world for an imminent attack". The happy-go-lucky virologist, John Oxford, said half the population could be infected, and that his lowest estimate was 6,000 dead.

The "Andromeda strain" was stalking the earth, and its first victims were clearly scientists. Drugs were frantically stockpiled and key workers identified as vital to be saved for humanity's future. Cobra alerted the army. Morgues were told to stand ready. The Green party blamed intensive pig farming. The Guardian listed "the top 10 plague books".

If anyone dared question this drivel, they were dismissed by Donaldson as "extremists". When people started reporting swine flu to be even milder than ordinary flu, he accused them of complacency and told them to "wait for next winter". He was already buying 32m masks and spending more than £1bn on Tamiflu and vaccines. Surgeries refused entry to those with flu symptoms, referring them to a government "hotline" where prescription drugs were ordered to be made available without examination or doctor's note. Who knows how many died of undiagnosed illness as a result? Lines were instantly jammed. It was pure, systematic government-induced panic – in which I accept that the media played its joyful part.

This week the authorities admitted that, far from a winter upturn in swine flu, there has been a slump. From 100,000 a week at the peak, there were just 12,000 last week. After the coldest winter for decades, when deaths might be expected to rise, the rate is below that of seasonal flu. In the UK, 360 people have died under its influence, most with prior "non-flu" conditions. Swine flu is not nice – I have had it – but bears no ­relation to the government hysteria.

I accept that anyone can make a mistake, and authority has some duty to err on the side of caution. As Alastair Campbell implied on Tuesday, Iraq might have had weapons of mass destruction, so Blair was right to go to war just in case. But it is reasonable to ask, as the Chilcot inquiry is doing, why precaution on such a colossal and potentially ­destructive scale was justified when those who questioned the need for it have since been proved right. Is anyone asking about flu?

Swine flu is not the first time we have suffered this nonsense. I have a stack of predictions by senior scientists on BSE/CJD in 1995. It would "lead to 136,000 deaths" – a spurious exactitude used to convey plausibility – and "could infect up to 10 million Britons". This led to an obscene £5bn campaign of cattle destruction and compensation. When the prediction proved wildly wrong, the government excused itself with a classic Rumsfeld-ism: "The absence of evidence is not the evidence of absence."

This was followed by Sars 2003, a "panic gripping the world". The World Health Organisation declared that "One in four Britons could die". The medical doom-monger, Dr Patrick Dixon, said that Sars had "a 25% chance of killing tens of millions", whatever that meant. The madcap Tory health spokesman, Liam Fox, demanded the arrest and quarantining of all recent travellers from Asia, including 30,000 Asian students.

In the event, some 800 people died with Sars worldwide, against 21,000 who died in Britain in the seasonal flu epidemic of 1999/2000.

Undaunted, within a year the same alarmists were at work on avian flu. With now habitual hyperbole, Donaldson predicted 50,000 deaths, with "an upper limit", graciously conceded, of 750,000. When one dead swan slumped on a beach in Scotland, BBC reporters went crazy as inspectors stumbled through the seaweed, clad in anti-nuclear armour. Within a year the horror had passed. The global mortality was put at 262, with not one death in Britain. Another fiasco was brushed under the carpet.

The Blair government, and now Brown's, have proved adept at using scare politics to divert attention from other troubles. During foot-and-mouth Blair was quick to don a yellow jumpsuit for photographers and intone as if he alone stood between an illness (that is in fact harmless to humans) and armageddon. This time the swine flu coincided with two other "mystery diseases", MRSA and C-difficile, which killed 10,000 Britons in 2007 alone. But those deaths lay squarely at the doors of unclean NHS hospitals. Hence there were no scary stories or predictions about them from Donaldson.

Donaldson and his eager virologists will doubtless stick loyally to their predictions since it is "too early to be complacent". His allies at the BBC did their bit on Wednesday with a Horizon programme that turned a serious study of virology into grotesque scaremongering, with solemn music and voices crying, "there's no escape", "this could take a devilish turn", and "we don't even know how many viruses there are!" Children writhed in agony from smallpox.

Mad scientist syndrome is rampant. Had these scares been disseminated by a private firm, a local authority or a newspaper (as was anti-MMR), they would be damned from on high with demands that heads roll. As it is, the government's Scientific Advisory Group for Emergencies sails gaily on, still graced by the presence of Sir Roy Anderson, who ­happens also to draw a six-figure salary as a non-executive director of GlaxoSmithKline, which made hundreds of millions from the government's panic. Anderson, and GSK, vigorously deny any conflict of interest.

The Council of Europe's head of health, Wolfgang Wodarg, is one of the few who have dared blow the whistle on the links between "Big Pharma" and national and ­supranational agencies. He this week persuaded the council to stage a debate on the "enormous gains" made by GSK and others from the swine flu pandemic. He seeks details of relations between the companies and the WHO, given that stockpile contracts kick in the moment that ­organisation uses the word "pandemic". It did so for the first time last year, with reckless alacrity.

I am not aware of the WHO or the General Medical Council or any of the medical colleges investigating these matters, or any check on conflicts of interest of government doctors who work for drugs companies. I am not aware of any Whitehall or Commons committee, any National Audit Office or competition inquiry into the supply of these drugs. All I know is that a huge amount of health money, time and effort was last year diverted from possibly critical therapies into what looked from the start to be yet more terror virology.

This is why people are ever more sceptical of scientists. Why should they believe what "experts" say when they can be so wrong and with such impunity? Weapons of mass destruction, lethal viruses, nuclear radiation, global warming … why should we believe a word of it? And it is a short step from don't believe to don't care.

Millions of doses of swine flu vaccine to be off-loaded

What do you do with vaccine that no-one needs?

That is the question currently puzzling the Department of Health. Back in May the government signed contracts with two suppliers - GSK and Baxter - to supply 90 million doses of H1N1 pandemic vaccine.

That was on the basis that two doses would be needed to provide protection. Swine flu has turned out to be far milder than was initially feared and so the government is going to be left with a huge amount of unused vaccine.

The Department of Health has revealed that it has a break clause in its contract with Baxter which had been asked to supply 30 million doses, but it appears there is no get-out clause in the deal with GSK, set to provide 60 million doses. GSK has so far delivered 23.9 million doses to the government and Baxter five million.

That is more than enough to vaccinate all the at-risk groups and the government made clear there are no plans to extend immunisation.

The Head of Immunisation at the Department of Health, Professor David Salisbury said: "The Baxter contract has a break clause. We are in discussion with GSK about future supplies of vaccine." When asked how much the government might be able to re-coup from the deal with GSK he said "That is what we are discussing now."

For commercial reasons no figure has been given for the cost of the vaccine contracts, but it's likely to run into several hundred million pounds. Professor Salisbury said there were a number of options which included selling excess doses or giving them away to developing countries.

But he added that it was essential that the UK kept a stockpile of H1N1 vaccine in case there was a resurgence of the virus over the coming year.

One option being discussed with GSK, which was described as "innovative" by the Chief Medical Officer Sir Liam Donaldson, would involve keeping a stockpile of adjuvant, the booster chemical which is produced separately from the vaccine and mixed later.

Professor Salisbury said this would be a good idea as it could be used in conjunction with another flu vaccine in the event of a new pandemic. He said the adjuvant had a shelf life of five years.

When asked whether the NHS would be left substantially out of pocket by purchasing so much H1N1 vaccine, Sir Liam said that the contracts were signed earlier this year amid the early and very alarming information about deaths from the virus in Mexico. The death rates in Mexico were later reduced.

Vaccine uptake

There are no accurate figures for the UK. But in England:

• At least one in three people in the initial priority groups has had the vaccine.
• 3.2 million doses have been administered.
• 113,000 pregnant women have had the jab out of around 600,000 - about one in five.
• 373,000 front-line health workers have had the jab out of around a million (there are no figures for uptake among front-line social care workers).
• 86,000 doses have been given to healthy children aged six months to under five out of more than three million, but this process only got underway before Christmas.

Professor Salisbury urged all those in the at-risk groups to get immunised, especially children under five because it was not clear what would happen with swine flu over the year ahead.

Swine flu figures

There is very little swine flu about. Latest figures show that there were fewer than 5,000 new cases in England over the past week. And disease "modellers" have advised the Department that a third wave of swine flu is unlikely this winter.

Sir Liam pointed out that there were the same experts who predicted that up to 65,000 people might die from swine flu this winter - a figure which was later downgraded to 1,000.

This lack of swine flu in the community will make it more difficult to persuade those at risk of flu complications to come forward to be immunised.

But the Chief Medical Officer Sir Liam Donaldson pointed out that 20 children under five and 12 pregnant women had died in the UK from swine flu related conditions since April.

To date there have been 360 deaths from swine flu in the UK (251 in England, 64 in Scotland, 28 in Wales and 17 in Northern Ireland). But the vast majority of those infected have had either a mild disease or no symptoms at all.

In England there were 393 people in hospital with swine flu on 6 January, 103 of them in critical care.

Children offered swine flu jabs

What will happen to swine flu in 2010?

We can all be grateful that the NHS did not have the Christmas or New Year it was expecting. Looking back to June last year, there was huge expectation that H1N1 swine flu would cause immense pressure on the health service with predictions that intensive care could face its toughest challenge in forty years.

Swine flu has not entirely gone away, and there are still patients critically ill in hospital with the complications of the virus. But it is nothing like as bad as had been feared. The latest figures from the Health Protection Agency show that cases continue to decline across the UK with the majority of infections being mild.

So what should we expect in 2010? Has swine flu had its day? Time for some New Year predictions, which will no doubt return to haunt me in months ahead.

Anyone who has studied the influenza virus will tell you that it is an unpredictable so-and-so, which makes forecasting rather difficult. But surely it is safe to say now that we are well over the worst of the first pandemic of the 21st Century?

We might get a bit of an upsurge in the coming weeks, but it should not be anything that the NHS couldn't handle.

The biggest concern would be virus mutation. But there are no tangible signs of a mutated H1N1 pandemic virus spreading in the community. So far, so reassuring - but let's wait and see what the year holds. So many people have been infected with swine flu that there is now quite a bit of herd immunity in Britain, which might itself force the virus to change its genetic make-up in order to keep circulating.

The H1N1 pandemic strain is being incorporated into the seasonal flu vaccine for the southern hemisphere, which will be distributed in a couple of months. The same will happen later this year for the northern hemisphere.

This means that by the time the next flu season comes round, in late autumn 2010, millions of us will either have had swine flu or have been immunised against it. So the second winter of swine flu should, hopefully, be as mild as the first.

PS: Many thanks for your comments in 2009, and a very Happy New Year to you all.

Welsh swine flu cases declining

Young people more likely to catch swine flu from an infected person in their household

Swine flu dominates health year

Swine flu cases continue to fall

I doubt the latest fall in H1N1 swine flu cases will warrant more than the briefest of mentions in the media, but this blog is there to report the good as well as the bad. And perhaps I should say the ugly, as I am typing this with a large amount of purple silicone goo in each ear. Before you wonder whether this is some strange BBC festive ritual, I am in fact having ear-pieces made for each ear - the clear plastic things which allow the editor or the director in the gallery to shout, cajole or bark instructions to me during live broadcasts.

Back to swine flu and there is more reassuring news today from across the UK. Cases of swine flu appear to be falling throughout the country. It means the second wave of the pandemic is on its way out, though there is still a chance of an upsurge in seasonal flu after Christmas.

Generally then, there is less flu about and most people who get it either are not aware they are infected or have a very mild disease. There were an estimated 9,000 new cases of swine flu in the past week in England, compared with 11,000 the week before. In Scotland there were around 8,000 cases, down from nearly 9,000 the week before. Cases are continuing to fall in Wales and Northern Ireland.

But there is another side to swine flu. In England there are more than 500 people in hospital with swine-flu-related conditions, more than 100 of them in intensive care. And there've been almost 300 deaths since the outbreak began in April. In the past week another 16 people have died across the UK. That's a tiny number compared to what was feared. But Sir Liam Donaldson, the Chief Medical Officer said:

"You can take a cold statistical view and look at the 300 deaths and throw your hat in the air. Or you can look at the families who may not have a child or a father or mother around the table this Christmas. If we can prevent those deaths then that is a reason to throw your hat in the air."

The numbers immunised against H1N1 swine flu continue to rise. I can't give you UK-wide figures at present, because the four nations don't collect their data in the same way, but I do have the statistics for England: three million people in the first priority groups have received the jab, including 101,000 pregnant women. 343,000 front line health workers have been vaccinated, about three times the number given the seasonal flu jab last year.

Two-thirds of primary care trusts in England have now reached agreement for GPs to immunise the under-fives and the others are said to be "very close" to signing up. The rise in immunisation may well help curb any third wave of swine flu.



As usual, have a look at the bold red line, which is good for showing trends and you'll see that flu-like illness rates with GPs have fallen below the baseline threshold of 30.0 per 100,000. This simply confirms that there is not that much flu about.

This is useful because it shows, contrary to what some might have imagined, that the second wave of flu this autumn has been bigger than the first in early summer. The peak in July was higher but it fell more quickly, whereas the second wave is craggier and longer-lasting.



This shows that, as well as having more cases, the second wave has seen many more hospitalisations.



The picture in the United States where consultations due to flu-like illness continue to fall - reassuring as in the previous two waves our peaks followed a few weeks after theirs.

Useful resources:

• Detailed UK weekly epidemiology update
• Swine flu figures for Northern Ireland
• Swine flu figures for Scotland
• Swine flu figures for Wales

The goo is out of my ears and my blog is done. I wish you all a peaceful and swine-flu free festive period. I will try to blog over the festive period as and when there is news to report.

Swine flu 'less lethal than was feared'

New research has estimated that there have been 26 deaths out of every 100,000 cases of swine flu in England.

The authors say this makes the first pandemic of the 21st Century "considerably less lethal than was feared in advance". No surprises there, but it is the first time we've had a figure for death rates in this country.

The study, published online in the British Medical Journal was carried out by a research team at the Department of Health.

It concludes that swine flu has a fatality rate of 0.026% or put another away, about one death in every 3,800 people infected.

That would make it 10 times less lethal than flu pandemics in the 50s and 60s and 100 times less dangerous than the pandemic of 1918-19. So-called Spanish flu is thought to have killed at least 50 million people, more than died in the World War I.

It's worth pointing out that all estimates of deaths from flu pandemics are subject to very wide variation. Increases in fatality are usually worked out more than a year later by analysing trends in death rates and calculating the likely proportion due to flu.

This is the first time that individual deaths from a pandemic flu virus have been counted. The Centers for Disease Control and Prevention estimate for deaths in the United States is similar at 0.018%.

The Chief Medical Officer, Sir Liam Donaldson said improvements in nutrition, housing and health care might explain some of the apparent decrease in fatality from one pandemic to the next.

But even the comparatively low death rate of 0.026% may itself be a huge overestimate. That's because huge numbers of those infected have probably had swine flu without knowing it.

Recently the Health Protection Agency estimated that up to one in five schoolchildren have had the virus, half of them without showing symptoms.

Two thirds of those who died from swine flu would have been eligible for vaccination and the authors say this demonstrates the importance of immunising those at high risk of complications.

Swine flu: "considerably less lethal" than feared

Swine flu: second vaccine jab can give children fever, say experts

Government seeks advice on smaller doses after European Medicines Agency warns of temperatures topping 38C

Children who have been given a second injection of the vaccine against swine flu could develop a fever, European medical officials warned today.

The European Medicines Agency (EMEA) says parents and doctors should monitor the temperature of children who have received their second dose.

The warning could lead to the Department of Health shifting position and recommending that only a single dose of the vaccine is necessary for young children.

The update has been circulated as GPs in the UK prepare to deliver the vaccine to all healthy children under the age of five. Unlike adults, children are being given two half-dose shots, three weeks apart.

The EMEA says that the "increased reactogenicity" with the second dose of the influenza vaccine Pandemrix was "unexpected as [it had not been] seen with the mock-up vaccine". It was revealed following the release of fresh data from the manufacturer, GlaxoSmithKline.

The notice says: "Parents and carers of young children (below six years of age) vaccinated with Pandemrix should be aware that fever may occur, and that this fever can be high (above 38C) [over 100.4F]. They should monitor the child's temperature after each vaccination, and give a medicine such as paracetamol to control the fever as necessary."

Adverse reactions among young children aged between six months and three years, and reported by the manufacturers, included "soreness at the site of injection, drowsiness, irritability and loss of appetite after the second dose".

The European agency did, however, conclude that a "single dose of vaccine triggered a good immune response in young children" while a second dose did bring about further protection against catching swine flu.

It also recommended that doctors continued their vaccination programme "according to the recommendations given by the health authorities in each member state".

England's chief medical officer, Sir Liam Donaldson, has warned that the under-fives are suffering particularly badly with swine flu. The flu can cause trouble with breathing.

A Department of Health spokesman said: "It's good news that such a strong response is shown after just a half-dose of the Pandemrix swine flu vaccine is given to children. Our current guidance is for children under 10 to be given two half-doses, at least three weeks apart. However, we are now asking the Joint Committee on Vaccination and Immunisation, (an independent advisory committee), for advice on whether one half-dose of the Pandemrix vaccine is sufficient. New guidance will be developed as necessary.

"The vaccine is our best defence against swine flu. More than 10 million doses of the Pandemrix vaccine have been given across the EU, including to children, and no unexpected safety concerns have emerged."

Swine flu cases 'on the way down'

Swine flu deaths in Scotland

Swine flu vaccine is vital | Robert Read

The anti-immunisation movement has been peddling fear since the 1800s, but we must ignore its misinformation on H1N1

Many people are facing the question of whether to vaccinate themselves and their children against pandemic influenza H1N1 (so-called swine flu) – a vaccine that will provide safe and effective protection against a debilitating and potentially fatal illness. But the question comes at a time when some experts are concerned that a vociferous anti-vaccine lobby will undermine the mass vaccination campaigns being rolled out across Europe, putting the public and individuals' health at risk.

Vaccination – priming the body's immune system to resist attack – is the best defence an individual can have against infectious diseases. It can provide effective protection from infection, and means not having to face the uncertainty of whether treatment with anti-microbial drugs will be successful. Besides protecting us individually, vaccination also has a vital public health role because once the number of people immunised against an infection reaches a critical mass, that infection can no longer spread in the community.

Alongside improvements in sanitation, nutrition, and housing, vaccination has practically eliminated infectious diseases as a cause of childhood deaths in industrialised countries. Our children no longer die or are crippled by diphtheria, tetanus, whooping cough, or polio, to name a few examples. Even in the world's poorer countries that have yet to benefit from infrastructure improvements, vaccination has eradicated smallpox, is on the verge of doing the same for polio, and has cut deaths from measles by three quarters in the past decade alone. The countless millions of lives saved by vaccination are arguably science's greatest triumph.

The anti-vaccination movement took off in the 19th century as immunisation against smallpox was encouraged and, for example in the UK was then made compulsory by parliament in the 1840s and 1850s. As a 2002 article in the BMJ showed, arguments against the use of vaccines have barely changed in 150 years – opponents cite that they cause illness, they are ineffective, vaccination campaigns are an alliance for profit between government and industry, they are a poisonous chemical cocktail, immunity after vaccination is temporary, and a healthy lifestyle is an effective alternative. Yet in the past century and a half, anti-vaccines campaigners have produced no credible scientific evidence to support their arguments.

Concerns about the Pandemrix vaccine against H1N1, which is being widely distributed across Europe and in the UK, relate to whether it might itself cause flu, whether is has been adequately tested, and the safety of its component parts. The viral components in Pandemrix, which are necessary to stimulate immunity, are dead and cannot therefore cause an infection. The vaccine has been subjected to the same rigorous testing for safety and immunogenicity as seasonal flu vaccines, which have over the past 30 years had an unimpeachable safety record.

Clinical trials of Pandemrix among thousands of volunteers, including children as young as six months and the elderly, showed the vaccine produced a protective immune response in almost all those who received it, and raised no concerns about safety. The vaccine contains an adjuvant (designed to stimulate the immune response) based upon squalene; adjuvants of this type have been used in seasonal flu vaccines in Europe for more than 10 years without safety concerns. It also contains a preservative, thiomersal, which has had a controversial history, but whose safety is now backed by a mass of scientific data.

Although a milder illness than once feared, pandemic influenza is not a negligible disease. There have been an estimated 715,000 cases of H1N1 in the UK and 245 deaths. Children under five are particularly at risk of infection and serious illness, which is the reason why the vaccine is now being made available to this age group. About 80% of under-fives hospitalised for pandemic flu in the UK have no underlying health issues.

Reports from Wales of transmission from person to person of H1N1 virus resistant to the antiviral drug oseltamivir (Tamiflu) also raise concerns that treatment of pandemic flu may become difficult, and further emphasise the point that prevention is better than cure. Given that an effective vaccine without any known adverse event profile is available to prevent a disease with known potential for serious or even fatal illness, the decision to vaccinate seems an easy one to make.

Swine flu deaths in England reach highest level

Swine flu cases fall in England

Sixth patient tests positive for Tamiflu-resistant strain of swine flu in Cardiff

The number of people catching swine flu in England is falling, figures out today show.

There were an estimated 46,000 new cases in the last week, down from 53,000 in the week before. The number of people in hospital has also dropped, from 783 to 753. Of those, 154 are in intensive care.

The number of deaths linked to the virus rose to 163 from 142.

Experts confirmed today that a sixth person has tested positive for Tamiflu-resistant swine flu at the University Hospital of Wales in Cardiff. Five patients were diagnosed in the same hospital last week, in what could be the world's first cases of person-to-person transmission of the strain.

The National Public Health Service for Wales said the new patient was linked to the five people found to be resistant to Tamiflu last week and was tested as part of routine screening arrangements.

"Test results are still awaited on one other direct contact of the six patients with swine flu resistant to Tamiflu," it said. "All other patients on the unit have now tested negative for the virus."

Three of the patients remain in hospital, with one in critical care.

All patients diagnosed with Tamiflu-resistant swine flu have been treated with an alternative antiviral.

What treatments work for swine flu?

Swine flu causes an illness very much like seasonal flu. It can make you feel very ill, with a high temperature and cough. There are treatments that can help, and things you can do to cut your chances of getting the virus.

• The main drug being used to treat swine flu is called oseltamivir (brand name Tamiflu). You need to take it within 48 hours of getting symptoms, to get the most benefit.
• Basic hygiene precautions such as washing your hands frequently with soap and water should help protect against swine flu.
• The swine flu vaccine is likely to offer some protection against catching swine flu.
• There are things you can do to make yourself more comfortable while you're ill. See What can I do to help myself? to find out more.

We've looked closely at the research and ranked the treatments into categories, according to whether they work.

Treatments that are likely to work if you have swine flu

Oseltamivir (Tamiflu)

Oseltamivir (brand name Tamiflu) is an antiviral drug. It works by stopping the virus from reproducing. It works best in the first couple of days after you've been infected, when the virus is reproducing fast. If possible, you should start to take it within 48 hours of your symptoms starting.

It comes as capsules, or as a liquid for very young children who can't take capsules. You take it for five days.[3]

In the UK, most people with swine flu are offered treatment with oseltamivir. But pregnant women and people with chronic kidney disease may be treated with a similar type of antiviral drug, called zanamivir (brand name Relenza), instead.[4] See below for more information about zanamivir.

There haven't been any good-quality studies looking at oseltamivir for treating people with swine flu. But we know from other studies that it works against seasonal flu.[5] Also, studies carried out in the laboratory show that this type of swine flu is susceptible to oseltamivir.[6]

Oseltamivir isn't a cure for flu. This is how it helps:[5]

• It may cut the time you are ill by one to two days.
• You may be able to get back to your normal activities faster
• You may be less likely to get complications, including bronchitis and pneumonia for adults, and ear infections for children.

A more recent review of the evidence questioned how much benefit children with flu get from oseltamivir. It may cut the chances of getting ear infections or asthma attacks, if given early enough. But the evidence is not clear.[7]

Oseltamivir does have side effects. The main ones are feeling sick (nausea) and vomiting.[8]

The European Medicines Agency, which checks the safety of medicines used in Europe, has warned that a very small number of people taking oseltamivir may be at risk of injuring themselves, or having accidents. Some people taking the drug have experienced convulsions (fits), unusual behaviour and feelings of confusion (becoming delirious). If you are caring for someone taking oseltamivir, contact a doctor at once if they show any sign of unusual behaviour.[9]

A report on school children who were given oseltamivir to prevent the spread of swine flu, at the start of the outbreak, says that about half of children experienced some side effects.[10] Feeling sick, stomach pains, and trouble sleeping were the most commonly-reported side effects.

Is this drug safe for pregnant or breastfeeding women?

Oseltamivir seems to be safe to take during pregnancy or while breastfeeding.[11] Having a bad attack of flu can be dangerous for pregnant women, and for their babies, so doctors believe that it's much safer for pregnant women to take antiviral medicines like oseltamivir than to go without treatment.[2]

Studies of pregnant women who've taken oseltamivir have shown no signs that it can be harmful for unborn babies. And studies looking at breastfeeding mothers found that only tiny amounts of oseltamivir get into breast milk.[11] You should carry on breastfeeding your baby if you are taking oseltamivir for flu. But you may be advised to wear a mask, to avoid passing the virus to your baby when you cough or sneeze.

In the UK, the Health Protection Agency says pregnant women should normally be treated with zanamivir, because it comes as a spray straight to the lungs, instead of a capsule that spreads the drug around the body. That means it is less likely to affect the growing baby. See below for more information about zanamivir.[4]

Zanamivir (Relenza)

Zanamivir (Relenza) is also an antiviral drug. It comes as a dry powder that you breathe in through your mouth, using a device called a Diskhaler.

It works best in the first couple of days after you've been infected, while the virus is reproducing fast. If possible, you should start to take it within 48 hours of your symptoms starting. You'll need to take it for five days.[12]

In the UK, most people with swine flu are being treated with oseltamivir. But some people, including most pregnant women and people with chronic kidney disease, are being treated with zanamivir.[4]

There haven't been any good-quality studies looking at zanamivir for treating people with swine flu. But we know from studies that it works against seasonal flu.[5] Also, studies carried out in the laboratory show that this type of swine flu is susceptible to zanamivir.[6]

Zanamivir isn't a cure for flu. This is how it helps:[5] [8]

• It may cut the time you are ill by about one day
• You may be able to get back to your normal activities faster
• Zanamivir may reduce your chances of getting complications from flu, such as pneumonia.

A more recent review of the evidence questioned how much benefit children with flu get from zanamivir. One study said it had no effect on the chances of children getting complications such as ear infections. But the evidence is not clear.[7]

Zanamivir does have side effects. The main one is diarrhoea. Also, zanamivir shouldn't be used by people who have bad asthma, except under close medical supervision.[12]

There have been some reports of people becoming delirious and confused and injuring themselves while taking zanamivir. Children have been mainly affected and the symptoms go away quickly. We don't know if zanamivir causes these symptoms, as they often happen with the flu. If you are caring for someone taking zanamivir, contact a doctor if they show signs of unusual behaviour.[13]

Is this drug safe for pregnant or breastfeeding women?

There hasn't been much research looking at the effect of zanamivir on women who are pregnant and breastfeeding.[11] But having a bad attack of flu can be dangerous for pregnant women, and for their babies, so doctors believe that it's much safer for pregnant women to take antiviral medicines than to go without treatment.[2]

Before the current outbreak, very few pregnant women had taken zanamivir, so it's hard to say how safe it is in pregnancy. But in the UK, the Health Protection Agency says pregnant women should be treated with zanamivir, because it comes as a spray straight to the lungs, instead of a capsule that spreads the drug around the body. This means zanamivir is less likely to affect the growing baby through the mother's blood.[4]

Studies looking at breastfeeding found that only tiny amounts of zanamivir get into breast milk.[11] You should carry on breastfeeding your baby if you're taking zanamivir for flu. But you may be advised to wear a mask, to avoid passing the virus to your baby when you cough or sneeze.

Treatments that are likely to work to prevent swine flu

Washing your hands

Sensible hygiene precautions, such as regularly washing your hands with soap and hot water, help protect against swine flu (and any other type of cold or flu).

You don't need to use special hand-washes or alcohol hand rubs. One study showed that washing hands with soap and water got rid of as much, if not more, flu virus from people's hands, as alcohol hand rubs.[14]

Studies show regular hand-washing works well, especially for children. Anyone with small children knows they're often the first to pick up viruses. Good-quality studies found that increased hand-washing among young children cut the number who caught respiratory viruses. Studies of adults (for example, one looking at army recruits in barracks) also showed a reduction in respiratory diseases with increased hand-washing.[15]

One study says you need to wash your hands at least 10 times a day, but another says more than four times a day had an effect. Use common sense: wash hands if you've touched something lots of other people have touched (such as a handrail on public transport), after sneezing or coughing into a tissue or your hands, after using the toilet, and before eating or preparing food. You should also regularly clean hard surfaces, especially those that get touched a lot, in the workplace or at home.

Hand-washing doesn't guarantee that you won't catch swine flu. But it does reduce the chances. And if everyone followed basic hygiene measures, including coughing or sneezing into a tissue, fewer people would be infected overall.

Swine flu vaccine

The swine flu vaccine is especially designed to work against swine flu and is likely to offer you some protection against the disease.

Vaccines help your body make antibodies before it is infected by a virus. Antibodies are part of the body's immune system and they help fight off infections. So when you come into contact with the live flu virus, your body already knows how to fight it. The swine flu vaccine is prepared using proteins from the swine flu virus that have been made harmless in the laboratory.

Two brands of vaccine are to be used in the UK vaccination programme: Pandemrix, made by the drug manufacturer GlaxoSmithKline, and Celvapan, made by Baxter. Most people will have Pandemrix.

Pregnant women and people with chronic diseases were offered vaccination first, because they are more at risk of complications from swine flu. Young children aged six months to five years are also being offered the vaccine. Other groups of people may be added over time. If you need a vaccination, you'll be contacted by your GP surgery and invited to attend.[16]

The vaccine is not intended to replace the normal seasonal flu vaccine. If you normally have the seasonal flu vaccine, you may need both vaccines. Your local health care provider will tell you when you can come and be vaccinated.

People are expected to have two doses of the vaccine, three weeks apart. But research shows one dose might be enough for some people.[17] [18]

We don't know exactly how well the swine flu vaccine will cut the chances of getting swine flu. Normal flu vaccines reduce an adult's chance of getting flu by about 50 to 70 percent.[19] Research suggests that about 9 in 10 people who have the swine flu vaccine produce antibodies to swine flu.[17] [18] That should mean their immune system is prepared to fight off the virus, but it's not a guaranteed protection against swine flu.

The vaccine is unlikely to cause serious side effects. It is similar to vaccines for seasonal flu, which have been given to millions of people, and which rarely cause serious problems. So far, people in studies of swine flu vaccines have not had serious side effects.[17] [18]

The side effects most commonly reported in studies of Pandemrix include swollen lymph glands, headache, bruising, pain, soreness and swelling at the point where you have the injection, muscle and joint aches, and a high temperature. But all of these side effects are temporary and usually mild.[20]

Some people have an allergic reaction to vaccines. If you're allergic to eggs, tell your doctor. The Pandemrix swine flu vaccine uses eggs in its manufacturing process and you may be advised to have Celvepan instead. Celvepan is made differently, without the use of eggs.

There's been some concern about Guillain-Barré syndrome, a rare condition that causes temporary paralysis. It was linked with swine flu vaccine during a vaccination campaign in the US in 1976. But some researchers now think the unexpectedly high numbers of cases of Guillain-Barré in 1976 may have been caused by the flu virus itself, not the vaccine to prevent it.[21] Research carried out into flu vaccination since 1950 shows that you are seven times more likely to get Guillain-Barré syndrome after having a respiratory infection like flu, but there's no increased risk after having the flu vaccine.[22]

Treatments that work to prevent swine flu, but where harms may outweigh benefits

Oseltamivir (Tamiflu)

As well as helping people who already have swine flu, oseltamivir may cut the chances of someone getting swine flu symptoms, when they've come into contact with someone who has it.[5]

To prevent flu, you need to take oseltamivir for 10 days. It comes as a capsule, or as a liquid for children who can't take capsules.[3]

However, oseltamivir is not often used to prevent flu. Only people who are at high risk of complications from swine flu are being offered antiviral drugs to protect against it, if they are in close everyday contact with someone with swine flu.[23]

In the early days of the swine flu outbreak, antiviral drugs were given to everyone who'd come into close contact with someone with confirmed flu. The intention was to slow down the spread of the virus.[24]

But there are good reasons to stop doing this, once the virus is widespread. That's because:

• Antiviral drugs don't give you lasting protection against flu, like a vaccine does. With so many people infected, you'd need to take repeated courses of antiviral drugs to keep fighting off the virus.
• The more people who take antiviral drugs, the higher the chances that the virus will mutate and start to become resistant to the drugs. That means they won't work for people who are really sick with swine flu. So giving antiviral drugs to everyone who's come into contact with swine flu would be dangerous.[25]
• It's quite common to get side effects from oseltamivir, such as feeling sick and vomiting. It doesn't make sense to take drugs that cause side effects unless you will benefit from them. (See above for more information about the side effects of oseltamivir).

However, some people at high risk of complications if they got swine flu may be offered oseltamivir, if doctors think they need it. Oseltamivir works by stopping the flu virus from reproducing as fast.

There haven't been good quality studies of oseltamivir to prevent swine flu. But studies in people with seasonal flu show it can reduce your chances of getting flu, after being in contact with someone who has flu, by 60 percent to 90 percent.[5]

Zanamivir (Relenza)

As well as helping people who already have swine flu, zanamivir may cut the chances of someone getting swine flu symptoms, when they've come into contact with someone who has it.

To prevent flu, you need to take zanamivir for 10 days. It comes as a dry powder that you breathe in through your mouth, using a device called a Diskhaler.

However, zanamivir is not often used to prevent flu. Only people who are at high risk of complications from swine flu are being given antiviral drugs to protect against it, if they are in close everyday contact with someone with swine flu.[23]

In the early days of the swine flu outbreak, antiviral drugs were given to everyone who'd come into close contact with someone with confirmed flu. The intention was to slow down the spread of the virus.[24]

But there are good reasons to stop doing this, once the virus is widespread. That's because:

• Antiviral drugs don't give you lasting protection against flu, like a vaccine does. With so many people infected, you'd need to take repeated courses of antiviral drugs to keep fighting off the virus.
• The more people who take antiviral drugs, the higher the chances that the virus will mutate and start to become resistant to the drugs. That means they won't work for people who are really sick with swine flu. So giving antiviral drugs to everyone who's come into contact with swine flu would be dangerous.[25]
• Zanamivir may cause side effects, such as diarrhoea. There's no point taking medicine that causes side effects, unless it's going to be helpful. (See above for more details about the side effects of zanamivir).

However, some people at high risk of complications may be offered zanamivir, if doctors think they need it. Zanamivir works by stopping the flu virus from reproducing as fast.

There haven't been proper studies of zanamivir to prevent swine flu. But studies in people with seasonal flu show it can reduce your chances of getting flu, after being in contact with someone who has flu, by about 60 in 100 to 90 in 100.[5]

Treatments that need further study

Wearing a mask

You've probably seen lots of photos of people wearing masks to protect against swine flu. But there's no evidence that wearing masks on the street, or while going about your daily business, will protect you against swine flu.

Most of the studies of masks have been in hospitals, where health care workers caring for people with flu or other respiratory illnesses wear them to stop the virus spreading. Health care workers also wear disposable gowns and rubber gloves to prevent the spread of the virus.

Studies looking at the use of masks during the SARS (severe acute respiratory syndrome) outbreak in China during 2003 found they worked quite well, when combined with other protective clothing.[15] But the studies only looked at their use in hospital, not in the wider world.

One small study looked at whether wearing masks in the home helped when someone in the household had seasonal flu.[26] The study showed that masks might help prevent others in the home catching flu, when used alongside careful hand-washing, but the results weren't clear. The study only found an effect when people started improved hand-washing and wearing masks within 36 hours of the person getting symptoms. Everyone in the household was told to wear a mask.

Most masks are designed to stop you from passing on the germs you breathe out, not to stop germs getting in. And you'd have to change your mask every 90 minutes, because after that time it gets too damp with your breath to work properly. You'd need a big supply of masks, and to be sure to dispose of them carefully to avoid infecting people with the used mask.

Masks might be helpful in the following situations:[1]

• If you have swine flu, to avoid giving it to people who are caring for you
• If you are caring for someone at home with swine flu.

© BMJ Publishing Group Limited ("BMJ Group") 2010

What are the symptoms of swine flu?

Symptoms of swine flu are very similar to those of normal seasonal flu.

The most common symptoms for people with swine flu are:[1]

• High temperature (38°C or above)
• Sore throat
• Cough.

You may also feel very tired, get aches and pains in your muscles, sneeze, feel sick or vomit, or get diarrhoea.

How ill people get with swine flu seems to vary a lot from person to person. Some people have described swine flu as being like a bad cold.[2] Others have been much more ill, needing several weeks in bed.[3]

So far, the swine flu virus seems to have affected children and young adults more than older people. In Japan, 8 out of 10 infections diagnosed by June 2009 were in teenagers.[4] This may be because viruses spread fastest through places like schools and colleges, where young people gather in crowds. Or it may be because older people have some natural immunity to the virus, because it is similar to a type that was around in the 1950s.[5]

Most people will not need to see a doctor, or have tests, to be diagnosed with swine flu. If you think you have symptoms of swine flu, you should call the National Pandemic Flu Service on 0800 1513 100 or visit the website (http://www.direct.gov.uk/pandemicflu). You will be asked to answer questions about your symptoms and about your health. If necessary, you'll be prescribed antiviral medicine.[6]

But these arrangements only apply in England. In Scotland, you should call NHS 24 on 08454 242424. In Wales, call NHS Direct Wales on 0845 4647. In Northern Ireland, call the swine flu helpline on 0800 0514 142.

Some groups of people have been advised to contact their GP directly, rather than go through the website or pandemic flu service phone line. Call your GP directly if:[6]

• You have a serious underlying illness such as asthma or heart failure
• You are pregnant
• You have a sick child under 1 year old
• Your condition suddenly gets much worse
• Your condition is still getting worse after seven days (five days for a child).

© BMJ Publishing Group Limited ("BMJ Group") 2009

What is swine flu?

Swine flu is an infection of your airways. It's caused by a new strain of influenza virus, which started in pigs. It causes an illness very much like seasonal flu.

There are many different types of flu virus. The one we're dealing with here is called influenza A H1N1 2009. It was first spotted in humans in early 2009, although it may have been infecting pigs for months or years before that.[1] It's been called swine flu because it first infected pigs. It probably spread first to people working with pigs, in Mexico and the US.

The reason experts worry about a new strain is that people haven't built up an immunity to fight it off. So we don't know how widely it will spread, or how severely it will affect people. During the last century, outbreaks of new types of flu caused many deaths. However, this virus does not seem to be as dangerous as those that caused large outbreaks during the 20th century.[1] [2]

The swine flu virus lives in your nose, your throat and the air passages leading to your lungs. The most common symptoms of swine flu are high temperature, cough and sore throat.[3] The swine flu virus can also cause more serious problems, such as pneumonia, although this is not common.

Swine flu spreads very easily from person to person. It passes around in the way normal seasonal flu, or colds, pass around. You can catch it from airborne droplets when people cough or sneeze, and by touching surfaces which have been infected by these droplets.[4]

You can get swine flu from someone while they are ill, or a few days before they have any symptoms. Experts have calculated that each person with swine flu is likely to infect two to three other people.[5]

There are plenty of sensible hygiene precautions you can take to cut your chances of getting swine flu, or spreading it around.

To find out more, see our page on What treatments work for swine flu?

© BMJ Publishing Group Limited ("BMJ Group") 2009

Scots swine flu death total at 43

Panic over hundreds of flu deaths exploited by Ukraine's politicians

A flu pandemic in Ukraine that has triggered a nationwide panic is worsening this weekend with up to 400 deaths already reported.

The arrival of the virus, suspected by the World Health Organisation to be swine flu but possibly a combination of the H1N1 strain and a respiratory illness, has paralysed the country's fragile health system and could even lead to the postponement of the general election which is scheduled for 17 January.

Seven people died and 35,000 new cases were reported on Friday, said the health minister, bringing the total number of people infected to 1.6 million out of a population of 46 million.

The onslaught of the virus has seen all the major political figures eagerly exploiting the outbreak. Prime minister Yulia Tymoshenko announced the arrival of an epidemic on 30 October, when only one case had been reported, and has closed all schools and banned public gatherings – including campaigning political rallies – for the past three weeks.

Her standing in the polls has shot up after frequent TV appearances, urging people to take care and criticising her political foes for inaction. Tymoshenko even went to the airport to greet a shipment of Tamiflu, prompting president Yushchenko to send one of his own representatives. President Viktor Yushchenko, who is still the electoral front runner but facing an ever narrowing gap with Tymoshenko, has been trying to match her by pledging to spend his campaign funds on medical supplies and 20 million face masks.

"This is very dangerous,' said Igor Shkrobanets, chief of the health ministry in the western district of Chernivtsi. "One or another politician will gain from this situation, but the doctors and their patients certainly will not."

He said the level of fear was such that people were calling out ambulances when they felt the first touch of a fever and hospitals were "overloaded".

In such uneasy times, bloggers and conspiracy theorists have whipped up fears by suggesting that bubonic plague, or a new, more lethal strain of the flu, was sweeping Ukraine and that there was a massive cover-up of the numbers of deaths.

"We are seeing reports of bodies lying in the streets," said one. Others claim to have seen reports of doctors mystified by the state of a patient's lungs after death. But with no authoritative medical analysis of the cases available, such amateur diagnosis has run riot.

The isolation of many Ukrainian towns, especially as winter closes in, combined with the lack of public trust in the weak government and the inexperience of many of the new, 24-hour media outlets, was fuelling the rumour-mongering and the scare stories, said one of the staff at the English-language Kyiv Post.

Semon Gluzman, a psychiatrist in the capital, Kiev, told the Washington Post: "What we're seeing is a normal psychological reaction to the complete incompetence of the state authorities. People are scared and they don't know who to trust any more."

The scare has also led to people hoarding surgical masks and flu remedies, which are now almost impossible to find. Even lemons and garlic, homemade cures for flu, are in short supply.

On Thursday the country received humanitarian aid from 13 nations, the WHO and two Ukrainian charities, and is in talks with six more countries about help with the outbreak. Swine flu pandemics are also being reported in Belarus, Moldova, Poland and Hungary.

• This article was amended on Thursday 26 November 2009. An error introduced at the editing stage referred to Viktor Yanukovych as "President" but he is a leading opposition politician and is head of the Party of Regions. The President of Ukraine is Viktor Yushchenko. This has been corrected.

Person-to-person spread of Tamiflu-resistant strain of swine flu

Health officials in Wales say a strain of Tamiflu-resistant H1N1 swine flu has passed from person to person in a Cardiff hospital. The first news of this story was broken on this blog just a couple of hours ago. The National Public Health Service for Wales says that five patients at the University Hospital of Wales in Cardiff were all diagnosed with swine flu resistant to Tamiflu. All have severe underlying health conditions. Three appear to have acquired the infection in hospital.

We know that sporadic resistance to Tamiflu has developed in individuals being treated for swine flu. But this appears to be the first definite case in the world of person-to-person transmission of a Tamiflu-resistant strain. Another case reported in the United States by the CDC in September had a number of other possible explanations.

In truth it's not easy to be absolutely certain that there has been person-to-person transmission in Wales. Chris Lines, director of communications for Public Health Wales, said "we can't find any other explanation for this, so our confirmation of person-to-person spread is based on the lack of evidence of any other means of transmission."

He gave some more detail about the patients: "Of the five, two have recovered and been discharged having recovered. Of the three in hospital, one is in critical care and two are on the wards but being isolated from other patients."

So how important is this? Hopefully this will be a viral dead-end and it won't go any further. I'm told all the patients were immunocompromised and so especially vulnerable to developing Tamiflu resistance.

Dr Roland Salmon, director of the NPHS Communicable Disease Surveillance Centre, said:

"The emergence of influenza A viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment."

Finally, just to stress, there's no evidence or suggestion that a "new" Tamiflu-resistant strain of H1N1 virus is now "out there" in the community. But public health officials in Wales will be very busy this weekend tracing contacts to ensure they have contained this among this small group of patients.