From The Times, 27 October 2010 (Story by Sam Lister, Health Editor)
Seventy children died from swine flu in England during the nine months of the pandemic, with death rates higher among the Bangladeshi and Pakistani communities.
A study by Sir Liam Donaldson, the former Chief Medical Officer who led the country’s swine flu response, shows the impact that the H1N1 virus had on the under-18s. In a normal flu season, almost all deaths are in the over-65s, and young victims have serious underlying conditions.
Although most children who died during the pandemic had pre-existing conditions, especially neurological diseases such as cerebral palsy, 15 of the victims were previously healthy.
Sir Liam told The Times that the patterns of infection and mortality suggested that ethnic minority children should be added to the higher risk groups for seasonal flu vaccination. He added that the evidence would be considered by the Joint Committee on Vaccination and Immunisation, which is compiling a report on the issue of whether to recommend all children have seasonal flu jabs. The committee is due to report back early next year.
The H1N1 virus is still circulating globally, and although the World Health Organisation declared the pandemic over in August, it has now taken over as the main seasonal flu strain and is part of this year’s flu vaccine.
Last week researchers reported that the H1N1 virus might be starting to mutate, and a slightly new form has begun to predominate in Australia, New Zealand and Singapore. They said that more study was needed to tell whether the new strain was more dangerous and whether vaccines could protect against it. Flu viruses mutate constantly but since swine flu emerged it has been stable, helping a herd immunity to build up and control its impact.
The Department of Health policy is for the flu vaccine to be offered to the over-65s and anyone with underlying medical conditions such as respiratory, heart disease and diabetes.
Sir Liam said: “Adding ethnic-minority children into existing risk groups needs to be looked at very seriously. When H1N1 comes into the seasonal flu cycle, will it behave like a pandemic virus or like a seasonal flu virus and revert to attacking the elderly more? It needs to be watched closely, and if it takes up a pandemic pattern it poses the question as to whether all children should be routinely vaccinated?”
The study, published in The Lancet, is the first detailed analysis of paediatric mortality during the pandemic, which started in England in April last year. There are no published studies to date on paediatric mortality from swine flu in the rest of the UK. Of the 70 people under the age of 18 to die, 27 were of Asian descent, of whom 6 were Bangladeshi and 11 were Pakistani. Sir Liam said that although the numbers were small, the rate per head of population was much higher than would have been expected. It was equivalent to 47 deaths per million population for Bangladeshi, and 36 deaths for Pakistani — compared with four deaths per million for white children. A total of 37 white children under 18 died.
Sir Liam, who chairs the National Patient Safety Agency, said that the prevalence of the virus in the West Midlands and London — areas with high Asian populations — had been considered, but the theory was not supported by the Asian death toll in areas with fewer Asian residents. “There is something here that we don’t understand to do with greater susceptibility, whether to do with a general [genetic] predisposition or a particular lifestyle factor.”
Sir Liam and his co-researcher, Nabihah Sachedina, from the Department of Health, called for international data to be pooled to provide a higher number of cases for analysis.
Swine flu jabs for pregnant women
From The Times, 30 September 2010 (Story by David Rose, Health Correspondent)
All pregnant women will be offered a flu vaccine this winter to guard against a resurgence of swine flu.
The H1N1 flu strain that triggered a global pandemic last year is likely to return in the coming months as a typical form of winter flu, experts say. Expectant mothers are considered at particular risk of serious complications from the virus.
The Department of Health said that, from next week, pregnant women would be offered free vaccinations for the first time as part of the annual NHS seasonal flu campaign.
David Salisbury, the Government’s Director of Immunisations, said that it was impossible to predict how the virus would behave as it circulated alongside other flu strains this winter.
Children and adults who had caught the virus or received a separate swine flu vaccine last year may have some residual immunity, he said. But he added that it would be “foolhardy” for those in at-risk groups — including over-65s and pregnant women — to refuse to have the vaccine.
“Not to have the vaccine because you are prejudiced against swine flu is putting yourself at unnecessary risk,” he said.
“As we know that this virus can pose additional risks to pregnant women, we are recommending this year that all pregnant women are vaccinated.”
The vast majority of the 800,000 Britons who caught swine flu last year experienced mild symptoms or recovered on their own, but at least 457 deaths were linked to the virus between April last year and March this year.
Recent studies suggest that pregnant women were four times more likely than other groups to be treated in hospital with complications from the H1N1 virus last year, and were also more likely to die as a result of contracting the virus.
Each year, seasonal flu strains contribute to an estimated 8,000 deaths each winter, but vaccines have to be reformulated each winter to match the current flu strains in circulation.