Oral - Update on Swine Flu

This statement updates Members about developments in respect of the influenza A(H1N1) swine flu outbreak during the summer and outlines our future plans. The clinical consultation rate for influenza in Wales fell steadily throughout the summer, from a peak of over 4,400 at the end of July to 459 during the week ending 16 September. This is still higher than usual for this time of year; however, levels are below the range normally seen in the winter.

A total of 123 laboratory-confirmed cases of swine flu have been reported by National Public Health Service for Wales health protection teams as of 16 September. Of the laboratory-confirmed cases, 48 people confirmed with swine flu in Wales have been admitted to hospital and one remains there. While the virus remains mild in the majority of people, continued vigilance is necessary because, for some, it can still cause serious illness. Sadly, in August, we saw the first—and, so far, only—swine flu related death of a person in Wales.

Although the first wave of the swine flu has peaked, a second wave is anticipated this winter, but its timing is uncertain. The national health service and other key services across Wales are dealing well with the pandemic, with no current areas of pressure on services. Our approach has the support of professional bodies in primary and secondary care services and I would like to thank all the staff who have responded so well, especially in our primary care services, who have played a key role in managing the outbreak and have borne the brunt of the additional burden. We are keeping a close eye on the implications of children returning to school this month. We know that the return to school normally results in an increase in common infectious diseases, so we need to be vigilant. We have provided schools, childcare settings and local authorities with clear guidance and updated question-and-answer advice, including draft letters to send to parents covering a number of scenarios. Together with my colleague Jane Hutt, I am monitoring the position carefully each week.

In mid July, England decided to launch the national pandemic flu service, because of the significant pressure faced by GPs and accident and emergency services in England. Wales, Scotland and Northern Ireland decided not to join the NPFS; instead, we strengthened primary care services to ensure that antiviral treatment was targeted at those most likely to benefit from it. I firmly believe that this measured approach was the right one to adopt in the particular circumstances that we faced in Wales.

Members will be aware that the planning assumptions for swine flu have recently been revised. Following careful analysis of the latest scientific evidence on the H1N1 virus, and new data becoming available from the UK and other countries across the world, estimates for the worst-case scenario in the current pandemic have been lowered.

The main changes in the planning assumptions are: a reduction of the rate of hospitalisation, from 2 per cent to 1 per cent; a reduction in the projections of excess deaths from 0.35 per cent to 0.1 per cent; and that a substantial peak cannot now occur until October at the earliest. We still expect that up to one in three of the population may become ill over the course of the pandemic. It is important to stress that these are planning assumptions, based on a reasonable worst-case scenario; they are not a prediction of what we expect to see. This new information will be used to help the NHS, local planners and businesses to prepare. The planning assumptions will be kept under constant review as we learn more about this pandemic. Scientists will be looking particularly closely at how seasonal flu and swine flu interact as we move into the traditional flu season.

During the peak weeks of a pandemic there is the potential for a shortfall in the number of critical care beds that may be needed. Two weeks ago, we announced plans to double critical-care-bed capacity if required during the swine flu pandemic. I wrote to Members earlier today setting out the details of the critical care strategy for Wales.

Officials and Dr George Findlay, the Wales representative for critical care, are working closely with UK-wide specialist advisory groups. The NHS in Wales is also required to ensure that it has identified all suitably qualified staff who can be called on to care for critically ill patients. We will be testing the resilience of these arrangements over the next few weeks.

Turning to vaccines, two pandemic influenza vaccines are currently under trial. Vaccinations will not begin until licenses have been obtained, in accordance with European regulatory requirements. Once this has occurred, vaccination of the agreed priority groups will begin. The vaccine manufacturers anticipate that licenses will be granted in October, with supplies to the NHS in the four countries beginning shortly after that.

Safety data will continue to be collected once the vaccine is in use. In the UK, post-licensing monitoring of both effectiveness and safety, including the side effects of all vaccines, is well established. This will be undertaken by the Medicines and Healthcare Products Regulatory Agency, whose reporting system is being strengthened specifically to monitor swine flu vaccines.

The priority groups for immunisation, as recommended by the Joint Committee on Vaccination and Immunisation, and as endorsed by the Scientific Advisory Group for Emergencies, are: people aged over six months—it seems strange to say 'people’ when mentioning six months of age—and under 65 years who are in the current seasonal flu vaccine clinical at-risk groups; all pregnant women, subject to licensing considerations; household contacts of people with compromised immune systems, for example people in regular close contact with patients undergoing treatment for cancer, and so on; and people aged 65 and over in the current seasonal flu vaccine clinical at-risk groups. Vaccination of front-line health and social care workers will begin at the same time as the at-risk groups. Protecting these people will help the workforce to remain resilient and able to treat sick patients. The vaccination programme will be entirely voluntary—there are no plans to introduce compulsory vaccination as part of the UK’s pandemic preparations.

Last week, I announced that GPs will administer the vaccination programme for these priority groups. GPs are used to delivering large-scale vaccination programmes that target patients at highest risk. This agreement means that GPs and their teams will have the resources that they need to take on the additional workload and run the vaccination programme smoothly and efficiently. The collection date for the data on childhood immunisations will be delayed by six weeks to mid-February to allow practices time to carry out the swine flu vaccination programme.

It is vital to continue to stress the importance of key public health messages, such as good hand hygiene, in our fight against swine flu. To this end, a further advertising campaign was undertaken in Wales on 12 August. Advertisements in the regional press were supported by a radio broadcast campaign, while a fact sheet will provide further information on how to recognise the symptoms and reduce the spread of the virus. The fact sheet is also available on the Assembly Government’s website, in twelve languages.

Further waves of advertising will be launched through the autumn. In addition to the information leaflet and publicity campaign, information is available to members of the public on the Welsh Assembly Government and National Public Health Service websites. NHS Direct and the swine flu information line also provide help and information. I will continue to provide regular reports to Members, and updates will continue to be published on the Welsh Assembly Government’s website.