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Saturday, 26 September 2009

Swine Flu Q&A

Why are we still talking about swine flu?

Pandemics of the past show us that the first wave of infection is followed by a second bigger wave. Children transmit the virus much more easily than adults, and experts think the summer outbreak died down because the schools closed for the summer holidays. The number of cases in Scotland started to rise as soon as the autumn term began so a second wave this autumn/winter looks likely.

Wasn't it all over-hyped the first time round?

The situation in Mexico seemed to suggest we were heading for a deadly pandemic. We still don't fully understand why there were so many deaths and cases needing hospital treatment in Mexico, but it may have been because there were other viruses around at the time, and swine flu may have been more prevalent in the population than the authorities thought (i.e a low death rate compared to the total number of cases.) We now know that H1N1 is a very mild virus. 1 in 100 of all the people who catch it will go to hospital, and only 1 in 1,000 will die. That is broadly in line with the death rate from normal seasonal flu. Encouragingly, even those who need intensive care have a good chance of survival. However, unlike seasonal flu, this virus disproportionately affects the under-60's. This means there will be a larger impact on the workforce, because they will be ill themselves or looking after ill children. The vast majority will recover after about a week, but employers (including the NHS) may have to cope with large levels of staff sickness.

Should I have the vaccine? Is it safe?

Tried and tested methods are used to make all flu vaccines. Each time there is a new strain of flu, scientists deactivate the virus and add that to the basic vaccine to give you the protective effect. Extensive trials will have been carried out on the swine flu vaccine to make sure it is safe before it is released. However, no trials can predict extremely rare reactions which may occur in a very small number of people.

The chances of you becoming seriously ill with swine flu are small. The chance of you dying from swine flu is even smaller. But the chance of you dying or being seriously affected by a swine flu vaccine is absolutely miniscule. It is up to you which risk you would prefer to take!

The vaccine should become available in October and priority will be given to frontline health and social care workers, those living in the same household as people with suppressed immune systems, those in 'at-risk' groups such as people with asthma, and pregnant women (if experts decide it is safe for pregnant women.)

I'm pregnant, what should I do?

You are at no higher risk of catching the virus than anyone else, but if you do catch it you are at increased risk of complications including miscarriage, particularly if you are in the third trimester of pregnancy. If the vaccine is licensed for pregnant women, you should seriously consider having it (see above). In the meantime research has shown that good hygiene, such as regular hand washing, can be extremely effective in preventing you getting the virus. I was at a swine flu conference recently and a panel of swine flu experts were asked if they would discourage a daughter from becoming pregnant at this time - they all said 'no'.

Should my child's school close if there is an outbreak?

During the first outbreak of swine flu the Scottish government advised some schools to close to try to limit the spread of the virus. However, there is a danger that the reaction to the pandemic is worse than the pandemic itself. If large numbers of schools are closed thousands of parents (including nurses and doctors) have to take time off work to look after their (largely healthy) children, business will be disrupted and the NHS will not have enough staff to treat those who are really ill. Most children will recover quickly so we can expect most schools to stay open unless large number of pupils and, in particular, staff are affected.

Do I still need to have the seasonal flu vaccine if I usually get it?

There is some interesting evidence that swine flu 'knocks out' other flu viruses. However I have heard experts disagree over this, so at the moment it looks like the government will recommend that you continue to have the seasonal flu vaccine if you normally get it. If that applies to you, you'll probably receive two flu vaccines: one for seasonal flu (which contains the H3N2 strain this year) and one for swine flu, or H1N1.

If I think I've got it, will I be tested?

Testing has been abandoned for most people because there are too many cases and we simply do not have enough labs to cope. Many other countries, including the USA, abandoned swab testing long before we did. However some GP surgeries are still testing patients in order to give the government's experts some indication of how widespread the virus is. Since the outbreak began many people have reported flu symptoms but only around two in every ten actually test positive for swine flu. There is some evidence that the swab test is not particularly accurate and experts think the vast majority of people who have swine flu never feel sick enough to visit their doctor, let alone be tested.

If I've got it, will I get antivirals like Tamiflu?

Your doctor can still prescribe antivirals, but as we learn more about the virus, so doctors are learning when antivirals can be most effective. Antivirals need to be taken early, but most people don't go to their doctor until they've had flu symptoms for three or four days, and by then they are already half-way through the illness. We also know that side effects, such as vomiting, are common and may be worse than the illness itself - although nothing to worry about. Your doctor should be able to give you sensible advice on whether antivirals are right for you. There is a wider debate about whether large-scale use of antivirals will encourage the virus to become resistant, and we are seeing a small number of resistant strains emerging. Interestingly, the largest number of resistant strains have been seen in countries which have not used antivirals as much as we have, so this may be due to the virus mutating in a random way.

BBC Scotland.

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