Pandemic (H1N1) 2009 Influenza – Update by Dr Tony Holohan, Chief Medical Officer, Department of Health and Children
Ireland is now experiencing a significant increase in the rate of Pandemic (H1N1) 2009 Influenza infection. This is now a national public health emergency. All the measures that we use to track influenza infection rates are increasing. We are now seeing influenza occurring at rates that have never been seen with seasonal influenza. This is particularly the case among children. This is leading to a significant increase in paediatric hospital activity and some planned scaling back of elective services in some of these settings has been necessary.
At this point, we estimate that about 2.5% of the population have been infected. The assumption which we have used to inform planning is that the first wave could lead to infection of up to 25% of the population. While the actual figure may not turn out to be this high, we can expect further increases in hospitalisations and deaths in the coming weeks and months. We are also likely to see a significant impact on our health system, on schools, on business and on other sectors.
Today, a significant phase of our response formally commences with the official roll-out of our mass vaccination plan, beginning with those in the clinically ‘at risk’ groups. These are people between the ages of 6 months and 65 years who have a chronic disease such as lung, heart, kidney, liver or nervous system disorders. It also includes women who are more than 14 weeks pregnant and up to six weeks after birth or people who have reduced immunity either as a result of a disease or a medication.
It is reassuring that Pandemic (H1N1) 2009 Influenza is a mild infection in the majority of people. Complications are more likely among people with underlying medical risks, in pregnancy and among younger children. Most people, however, make a full recovery by looking after themselves at home, drinking fluids and taking medication to control temperature and other symptoms. Some people will need to visit their GP to get antiviral medication or other medication to manage complications. Fewer than one in a hundred people require admission to hospital to manage their illness. Some of these people will require temporary assistance with mechanical ventilation.
We must not be complacent. Pandemic (H1N1) 2009 Influenza shows some important differences in behaviour from seasonal influenza. Significant complications can and do arise among people who are otherwise healthy. The experience in Ireland thus far has shown that more than half of the almost 500 people who have required admission to hospital do not have an underlying illness. There is no way of predicting who the people who experience complications are likely to be.
People can be assured that Ireland is well prepared by international standards. The plans that are in place are based on preparations that began as long ago as 2005 in the wake of SARS and in response to the potential threat of Avian (H5N1) Influenza. The international and national systems that have been developed as a result have allowed us to respond rapidly to a changing and dynamic situation. We have been able to secure sufficient supplies of vaccine. Our intention has been to get the basic messages to people in relation to the symptoms of Pandemic (H1N1) 2009 Influenza, how they should manage it and how, and when, to seek help.
We have a skilled and dedicated workforce in the health system. GPs, emergency departments, nursing services, intensive care units, public health professionals and others have been in the frontline of our response and have managed well. Clinical and public health guidelines have been changing as our understanding of the disease develops and each time our health professionals have absorbed these changes and acted accordingly.
We have worked very closely with other sectors such as education. The rates in school children suggest that there is likely to be significant absenteeism occurring in schools but schools seem to be managing well based on the relatively small reported number of school outbreaks. Credit is therefore due to parents, teachers, principals, Boards of Management and the Department of Education for responding in a measured and balanced way.
People can protect themselves and others by ensuring that those with symptoms stay out of work, school or other social settings for seven days after the onset of symptoms and by following the advice to always use a clean tissue when coughing or sneezing, which is then disposed of and to always wash hands thoroughly.
Now the priority is vaccination. It is the most effective means of preventing the spread of infection and protecting people at risk. The rates of infection in the population are such that we must ensure that we offer this vaccine as soon as is practicable to as many people as our vaccine supplies will allow.
Initially vaccination is being offered to those people who are clinically at highest risk of developing complications of Pandemic (H1N1) 2009 Influenza, as outlined above. These people who are clinically at high priority are being vaccinated for the most part through their General Practitioners. This is the most appropriate place for them to be vaccinated as their GP is familiar with them and their condition and, indeed, they are familiar with their own GP. Over 200,000 doses of vaccine have been made available to GPs over the last two weeks and many people in these groups will have already received their vaccine.
In some cases, where a GP has chosen not to participate in the programme, the GP will be able to direct his/her clinically at risk patients to HSE-run clinics. The times and locations of these clinics have been provided to all GPs and are available also through http://www.hse.ie/eng/health/az/S/Swine-flu/
We will shortly be moving to vaccinate pre-school children, school going children and people over the age of 65. We will then be moving to vaccinate the remainder of the population. Health care workers will be immunised in the coming weeks in parallel with the vaccination of high risk groups.
Vaccination will not give you the flu, but may lead to some soreness, swelling and redness in the area of the injection. In some people, it can cause more generalised symptoms including temperature rises, difficulty sleeping and aches and pains. These symptoms resolve within one to two days. In a very small number of people it can lead to an allergic reaction. Doctors and nurses giving the vaccine will need to be prepared to deal with patients who experience these symptoms.
I understand that some people may be concerned about taking a new vaccine. The overwhelming medical and scientific advice, both national and international, is that benefits far outweigh any possible risks associated with the vaccine. I would urge people to come forward for vaccination in line with the recommendations and prioritisation as set out in our national plan which will continue to be communicated throughout our campaign.
Further information available through http://www.hse.ie/eng/health/az/S/Swine-flu/ and 1800 941100