Swine Flu Update

Swine Flu continues to spread worldwide and is now present in at least 196 countries and territories. Estimates of numbers are hard to make. Officially there have been over 415,000 cases and only about 5000 confirmed deaths but the number of cases is likely to be considerably greater. In the UK and other countries of the northern hemisphere it is likely that numbers will increase during the winter, and there is also evidence of a corresponding fall off in the number of cases in the southern hemisphere. Tropical countries vary in their numbers of cases and in some, as initially in the UK, there has been a lot of media induced panic. 

Some countries are screening incoming travellers at airports. This is not at present very widespread but please check the Foreign and Commonwealth Office website below, or your own country website, for more specific information about which countries are placing restrictions such as these.

It remains important that if you have symptoms of swine flu you should not travel.

There is no widespread resistance to the commonly used antiviral oseltamivir (Tamiflu) though isolated cases have been reported. The advice continues that those with certain pre-existing conditions or in vulnerable groups listed on the websites below, should treat suspected swine flu with Tamiflu. In some counties including the UK it is recommend that all people with symptoms of swine flu should use Tamiflu though many disagree that this is necessary.

There have been no changes or mutations as far as is yet known in the Swine Flu virus and fears that it may become more dangerous have not come about

If you are travelling to a country where Tamiflu is not readily available you should consider taking a course of Tamiflu with you if you have any of the listed conditions listed on websites below. Alternatively you should be vaccinated against Swine Flu as this becomes more widely available.

In the UK the swine flu vaccination programme has just been started and initially this will be targeting those with pre-existing conditions and those at higher risk. This is at present only available through General Practitioners and InterHealth is not able to obtain, provide or administer swine flu vaccination.

We do however have limited supplies of Tamiflu for the few people who still wish to take supplies this with them, because of their own special circumstances.

For regular updates which give an overview of swine flu worldwide please see the website of the National Travel Health Network and Centre (NaTHNaC)

August 28th 2009

The information below supersedes all information previously posted on this website, but previous posts are included later.

The websites at the end of this section with a note of what they cover, give virtually all the detailed information you will need.

1. General situation
Swine flu continues to remain a generally mild illness, almost always self-curing within 5 to 7 days in healthy individuals. The rare exceptions to this are mainly in those with certain underlying health conditions, which include pregnancy, and also obesity, from new evidence coming out of Australia.

2. Current world distribution
As from July 16th The World Health Organisation suspended its routine country-by-country tracking of the numbers of confirmed swine flu cases as this was becoming impossible to maintain with any accuracy. It is assumed that swine flu will now spread to virtually all countries.

As of August 27th 2009, 177 countries had reported swine flu and there were 182,000 confirmed cases. However this is likely to be a gross underestimate. The number of cases being reported at the time of writing in the UK and the Northern Hemisphere, are generally declining but are predicted to rise rapidly as winter approaches. The picture is more mixed in the southern hemisphere and the tropics, with declines in the numbers of cases in some countries and increases in others. As yet there is no evidence that swine flu has mutated or become more serious.

3 . Basic advice for travellers
Travellers should follow the advice given by the Departments of Health in their country of origin. Information for those based in or travelling from the UK are to be found on the websites below, which are regularly updated.

4. Use of antivirals
Currently the UK recommends that all cases of suspected swine flu should be treated with antivirals. It is worth noting that the World Health Organisation has issued new guidelines which are at variance with those of the UK. They state “ Healthy individuals with uncomplicated illness do not need treatment with antivirals”. InterHealth recommends that this is the definitive advice that should be followed.

There are already reports of drug resistance to Tamiflu (oseltamivir) and there are also reports of swine flu having been found in poultry in Chile. These concerns underline the importance of keeping the few antiviral preparations currently available for use in severe cases and special circumstances.

5. UK Pandemic Flu Plan
The UK has activated a plan that was originally designed for an epidemic of a more serious form of flu or infectious illness. The result of this response and some inappropriate media coverage earlier in the summer caused a degree of panic, though this has currently settled down. It is likely that as cases increase again as winter approaches there will be further discussion about the most appropriate response. 

6. The new swine flu vaccine
This is currently undergoing clinical safety trials and is likely to be available for use in the UK by mid October. The National Health Service has prioritized those who will be offerred this first.. It will include children and adults between 6 months and 65 years who have underlying health conditions that could be exacerbated by flu. It also includes pregnant women, household contacts of those who have a compromised immune system, and those over 65. Frontline health care workers and social staff will also be included in this “first wave”. There is no priority for international aid workers, though the vaccine will become more widely available later in the autumn. Supplies are likely to be strictly controlled in the UK and probably in other countries also. As yet we do not know the range of side- effects which this vaccine may cause, so it is hard to predict how many people will wish to take up its use. More information will become available over the coming weeks.

7. Workplace policies in the UK if and when the epidemic increases in the autumn
These are likely to be revised and developed as more information becomes available and as we understand more about the nature of the epidemic and how it affects particular people. The golden rule remains as at present that those with confirmed or suspected swine flu should stay at home for 7 days or for 24 hours after their symptoms have gone, whichever is longer, and should try and avoid contact with other people. Just how this is applied or interpreted has remained the subject of some debate and we hope will be clarfiied as more information becomes available. In practice however, this means that on average affected staff will be off sick for about 5 working days.

8. The coming weeks
The situation with flu is constantly changing and just how swine flu, seasonal flu and avian flu may progress over the coming months is hard to predict. Current “best guesses” are that swine flu will probably be the predominant strain in many countries.

Further information

Many websites are available but those listed below probably give the most accurate and well-authenticated information:

www.direct.gov.uk/pandemicflu  
Details on action to take in the UK if you have suspected swine flu
 

http://www.nhs.uk/Conditions/Pandemic-flu/Pages/QA.aspx  
Questions and answers on all aspects of swine flu including underlying risk factors
http://www.nathnac.org/pro/clinical_updates/flu_270809.htm  and http://www.nathnac.org/pro/factsheets/h1n1.htm  

Information with special relevance to travellers to and from the UK, but also of value to travellers to and from any country.

www.who.int/csr/disease/swineflu/en/  
Latest information from the World Health Organisation in the context of worldwide travel including more techincal details.

Further information for those travelling abroad

Please read the InterHealth fact sheet on Tamiflu.

We are able to supply travellers with Tamiflu on a case by case basis, for those with underlying health conditions travelling to countries where supplies of Tamiflu may be hard to obtain. We are not able to supply Tamiflu to healthy travellers with no significant underlying health conditions nor can we provide bulk supplies. We are able to provide Tamiflu only to those who are InterHealth subscribers and not to the general public. Pregnant women should use zanamivir (Relenza), an inhaled preparation, rather than Tamiflu. We may be able to obtain this on a special case by case basis.

Please note that those with fever or with symptoms suggestive of Tamiflu are recommended not to travel. Some airlines will bar people with fever and some countries including China are monitoring arriving travellers, and will quarantine those with fever or symptoms suggestive of swine flu.

Further country-by-country information is available on the Foreign and Commonwealth website.
http://www.fco.gov.uk/en/travelling-and-living-overseas/swine-flu
In worrying over swine flu please remember that virtually all other normal travel health precautions are more important, including immunisations, prevention of malaria and other illnesses in the areas you will be visiting. Most important of all is to take precautions to reduce the risk of road traffic accidents, the biggest killer.