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Reserve swine flu vaccines released to fill flu jab shortfall
As the death count from this winter's flu outbreak rises to 50, GPs have now been authorised to begin giving patients doses of last year's stockpiled swine flu vaccine, to try to overcome the shortage of seasonal flu vaccines.
A week after The Department of Health reinstated a national flu prevention advertising campaign; it has now approved the release of 12.7m doses of the Pandemrix swine flu vaccine - stockpiled from the 2009-2010 outbreak which killed almost 500 people - for patients in 'at risk' groups including pregnant women, the over 65's and those with underlying health problems such as diabetes, obesity and respiratory problems.
Jacqui Hayat, Head of Clinical Negligence in the London office of Fentons Solicitors LLP, said: "Pandemrix, the pandemic swine flu vaccine that GPs and local NHS organisations can issue from today only protects against the H1N1 swine flu strain whereas the seasonal flu vaccines that should be widely available to all, protect against both the H1N1 and the H3N2 strain as well as the common seasonal influenza B strain."
Although those who are given the pandemic vaccine will have no protection against either the H3N2 or the B strain of flu, the move to distribute Pandemrix appears the sensible option as swine flu is now responsible for the majority of those falling ill this winter with 45 out of the 50 deaths recorded thus far as a result of swine flu infections.
The number of people critically ill in intensive care currently stands at around 850. Hundreds of surgical operations around the country - including hip and knee replacements as well as heart surgery - are being cancelled as hospitals scramble to free up beds for flu patients needing Extra Corporeal Membrane Oxygenation, a highly specialised treatment often seen as a last resort for flu victims. As deaths linked to flu increased by 11 last week, questions are being asked as to why there aren't enough vaccines to go around and why the move to release stockpiled supplies was not considered sooner.
"The difficulties in coping with this outbreak," said Jacqui, "have been significantly compounded by a shortage of vaccines and an apparent failure to alert the most vulnerable to seek inoculation."
Both of these tasks lie in the hands of GPs, who place orders in the summer directly from manufacturers based on an assessment of the number of doses they estimate will be needed for their patients in 'at risk' groups. Although vaccine uptake amongst those eligible for jabs on the NHS and deemed most at risk has caught up to last year's levels, there are real concerns that GPs may not have ordered enough to cope.
"It is very evident that errors have been made," said Jacqui, "with GPs not having ordered enough vaccines from manufacturers and The Department of Health deciding to abandon its flu jab advertising campaign prematurely.
"An inquiry is needed to address what seems to be a fundamental flaw in the way flu vaccines are procured in England," added Jacqui. "It was predicted at the end of the last pandemic that the H1N1 swine flu strain would be back in circulation during ordinary winter flu seasons for the next few years yet allowances that should have been made at the procurement stage to prepare for this do not seem to have been carried out."
Ministers have now ordered a review into the way the NHS procures seasonal flu vaccines and whether vaccines from now on should be purchased centrally in an effort to avoid future shortages. This could lead to health departments taking over from individual GP practices the job of ordering and paying for next winter's supplies in the same way that all childhood vaccines, such as for tetanus, diphtheria and MMR are currently obtained.
In Scotland there is central procurement of flu vaccines with pharmacists ordering supplies on behalf of GPs and the Scottish government independently stockpiling extra supplies in the event of an emergency, a stockpile believed to contain tens of thousands of surplus doses.
"It has since emerged that the Scottish government was never even asked whether it had any surplus vaccines to supply England despite it confirming that it has plenty," said Jacqui. "Instead, The Department of Health spent all of last week scouring European suppliers for vaccines to no avail due to the Continent battling its own flu problems."
According to the UK Vaccine Industry Group, some 14.7 million doses of seasonal vaccine have been delivered. Officials maintain that although there should be enough seasonal flu vaccines in the system as a whole, there appeared to be discrepancies in where stocks were in relation to where infected patients needed them most. NHS North East for instance, said some of its GP surgeries had exhausted stocks, while GPs in Bradford have been asked to share their surplus of vaccines with other practices.
Latest figures suggest this winter's flu season may be reaching a plateau as the number of GP consultations for flu symptoms enquiries in England dropped from 124 per 100,000 to 98 with calls to NHS Direct regarding flu symptoms dropping to below ten per cent. These figures however were based on a three-day week up until January 2nd and could merely be a result of under-reporting due to surgeries being closed over Christmas.
"Signs that show cases of flu are slowing down are of course encouraging," said Jacqui, "but the fact that schools have now reopened and the rest of us are all back at work after the Christmas break means we need to be very wary about declaring we are over the worst of this current outbreak just yet."
Despite the Health Protection Agency (HPA) confirming the country is currently in the grip of a severe outbreak, it is important to keep matters in perspective. Flu occurs every winter and although the HPA figures confirm the numbers affected are certainly higher than recent seasonal outbreaks, the current number of cases is around half the threshold level of 200 cases per 100,000 people that officially signifies a flu epidemic.
75% of cases are being caused by infection with the H1N1 virus and a significant number caused by influenza B, a milder form of flu that rarely causes concern. Most of those infected will endure a gruelling week off work followed by a second week of coughing and runny noses, before making a full recovery. A minority however will experience severe respiratory distress requiring hospitalisation. Amongst this group, for those with underlying health problems, the infection could well prove fatal.
"As awful as this may be," said Jacqui, "it is normal and despite the extensive media coverage this year the numbers we are seeing do not yet amount to an epidemic as seen for example in 2000 when flu infection figures crept above 200 cases per 100,000 people. Nevertheless, the Department of Health move to release stockpiles of H1N1 vaccine is clear evidence that there is concern current supplies are insufficient for the numbers of pregnant women and children with health problems such as asthma who are especially at risk."
Some parents anxious about their children contracting flu are taking them to private hospitals to get vaccinated despite quotes of £40 for a vaccine on top of a £180 consultation charge. £220 for a vaccination for an 'at risk' person known to be vulnerable who should be getting this kind of care for free is a lot to stomach for most families.
"The Government needs to do everything it possibly can," said Jacqui, "to resolve issues of local vaccine shortages, redouble GP efforts in targeting those most at risk, giving vaccines to children under five if the situation worsens, and ensuring there are enough intensive care beds free so that health professionals can work at clearing the growing backlog of cancelled or postponed surgical operations and thus minimise any potentially tragic consequences as a result. With proper planning and preparation there is no reason why we should be running short of vaccinations."
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