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Pandemic flu related content from the BMJ Group

BMJ blog: Informed consent, the doctor, and H1N1 immunisation (Thursday 19 November 2009): How does a doctor obtain informed consent for H1N1 immunisation consistent with General Medical Council guidance? The Department of Health’s guidance does not provide sufficient information for this. This is an attempt by Andrew Rouse and Tom Marshall to rectify this omission, providing information required for informed consent consistent with good professional practice.
Research: The economy-wide impact of pandemic influenza on the UK - a computable general equilibrium modelling experiment (Friday 20 November 2009): Balancing school closure against "business as usual" and obtaining sufficient stocks of effective vaccine are more important factors in determining the economic impact of an influenza pandemic than is the disease itself.
Editorial: The economic impact of pandemic influenza (Friday 20 November 2009): In the UK this could double the drop in GDP as a result of the recession
BMJ Learning module - Swine flu: Glasgow 'Any Flu Questions?' (Tuesday 17 November 2009): Dr Helen Morant chairs a Q&A session with a panel of experts live from Glasgow. Delegates at the BMJ Masterclass update for GPs put questions to Dr Dean Marshall, Dr Malcolm Mcwhirter, Dr Martin Donaghy and Dr Bill Mathewson. Recorded 10th November 2009 To take part in the next question and answer session, send your question to pandemic.podcast@bmjgroup.com.
Influenza surveillance, the swine-flu pandemic, and the importance of virology (Tuesday 17 November 2009): Coverage of the swine-flu pandemic seems incessant, with the media providing details of the latest number of new diagnoses of swine flu on a regular basis. But how accurate are these figures, especially those based on virological testing? As Douglas Fleming discusses, surveillance data collated by the Weekly Returns Service may provide evidence that virological testing is failing to detect swine flu, and that its incidence was much higher than generally believed.
Mary E Black on flu suits and holy water dispensers (Monday 16 November 2009): Plagues create business opportunities and the worried well in any era present a commercial opportunity. In the Middle Ages, the Black Death and the Great Plague saw brisk sales in fumigators, herbal remedies, and the plague suit - predecessor of the DuPont TK555T HazMat suit, and equally unsettling for nervous patients. Quacks (from the old Dutch word Quacksalver, for one who boasts or “quacks” about his or her salves) thrived in an era unchallenged by scientific evidence and online Cochrane reports.
Deaths from swine flu in UK rise, while cases fall (Monday 16 November 2009)
Only 12% of Germans say they will have H1N1 vaccine after row blows up over safety of adjuvants (Monday 20 July 2009)
WHO recommends early antiviral treatment for at risk groups with suspected swine flu (Monday 16 November 2009): People in groups at high risk of complications—such as pregnant women, children under 2 years old, and people with underlying medical conditions—and who are suspected of having swine flu should be treated promptly with antiviral drugs, the World Health Organization said on 12 November.
Tom Nolan: New pandemic flu guidelines - don’t forget your oximeter (Friday 13 November 2009): New guidelines on the management of pandemic H1N1 influenza were published recently by the Department of Health.
BMJ Learning module - Swine flu: secondary care (2) (Monday 09 November 2009): Dr Helen Morant interviews Dr Bruce Taylor and Dr Jake Dunning to get an update on issues regarding swine flu and secondary care. Recorded 2nd November 2009. To take part in the next question and answer session, send your question to pandemic.podcast@bmjgroup.com. This is also published as a BMJ Learning module. For the latest updates on all the BMJ’s flu content visit http://pandemicflu.bmj.com
Reassure pregnant women over swine flu vaccine, health officials urge (Monday 09 November 2009): England’s Department of Health has urged GPs to reassure pregnant women who are worried about being vaccinated against swine flu.
Joe Collier on swine flu and ministries of fear (Wednesday 04 November 2009): One thing about the current swine flu pandemic is that it has brought with it a universal sense of fear. As with all fears, individuals respond differently, but we know what they are feeling because the sensation of fear, which varies from a mild anxiety to incapacitating panic, is so much part of our constitution that some see it as a normal component of the human condition.
Does every new influenza reassortant virus qualify as a pandemic virus? (Tuesday 03 November 2009): The effects of the swine flu pandemic have, so far, been less severe than many had feared, raising the question as to whether this infection has in fact reached pandemic proportions. But when is the right time to declare a pandemic? The WHO have recently revised their own criteria, but predicting how much harm a virus strain will cause is notoriously difficult and often controversial. In his editorial, Peter Gross examines the impact of influenza over the last century, and discusses whether refining the pandemic criteria put forward by the WHO might reduce the risk of a false alarm.
News: Number of swine flu patients going into intensive care is rising (Monday 02 November 2009): The proportion of patients in hospital with swine flu who have been admitted to intensive care continues to rise in England, said the chief medical officer, Liam Donaldson, last week.
Tom Nolan on what every doctor should know about the swine flu vaccine (Friday 30 October 2009): The H1N1 vaccination programme is underway in the UK and many other countries across the globe. In Sweden a million people have already been vaccinated.
Acceptability of A/H1N1 vaccination during pandemic phase of influenza A/H1N1 in Hong Kong: population based cross sectional survey (Wednesday 28 October 2009): The uptake of vaccination against influenza A/H1N1 by the general population of Hong Kong is unlikely to be high and would be sensitive to personal cost. Evidence about safety and efficacy is critical in determining the prevalence of uptake of vaccination.
Best Practice topic: 2009 influenza A (H1N1) virus (Tuesday 27 October 2009): Best Practice, the online medical resource from the BMJ Evidence Centre has released a new, free access swine flu topic, providing detailed information on diagnosis, treatment and prevention. Recommendations are provided in an intuitive step-by-step format, and treatment information presented according to patient group, allowing fast navigation to the required information.
Cases of swine flu in England almost double in a week (Monday 26 October 2009): The number of patients with swine flu who required intensive care rose to its highest level so far in the epidemic last week, with 99 patients being admitted compared with 63 at the end of July.
BMJ Learning module: Swine flu vaccination - your questions answered (3) (Thursday 22 October 2009): BMJ Learning users put questions to Professor David Salisbury (DH) and Dr Peter Holden (BMA) on swine flu vaccination. Recorded 14th October 2009. To take part in the next question and answer session, send your question to pandemic.podcast@bmjgroup.com
News: H1N1 pandemic flu found to cause viral pneumonia in severe cases, says WHO (Monday 19 October 2009): The World Health Organization expressed heightened concern following the presentation of new evidence on clinical aspects of the H1N1 pandemic by experts from heavily affected countries ...
News: H1N1 vaccination begins as proportion of cases in hospital admitted to intensive care rises (Monday 19 October 2009): The swine flu vaccination programme will begin on Wednesday 21 October, when the first vaccines are distributed to acute trusts for use in "very high risk" patients and healthcare professionals, the chief medical officer Liam Donaldson has announced.
JECH Letter: Influenza A (H1N1) pandemic: true or false alarm (Thursday 15 October 2009): M F Allam suggests it is time to send out a message of calm and safety to the general population, and to prepare for combating the next expected wave of influenza A (H1N1) Journal of Epidemiology and Community Health 2009;63:862; doi:10.1136/jech.2009.094581 Copyright © 2009 by the BMJ Publishing Group Ltd.
JECH Editorial: Influenza A (H1N1) pandemic: true or false alarm (Thursday 15 October 2009): Dr Andrew Hayward discusses whether the World Health Organization (WHO) and mass media conclusions overestimated have exaggerated the problem of pandemic influenza. Journal of Epidemiology and Community Health 2009;63:775-776; doi:10.1136/jech.2009.096628 Copyright © 2009 by the BMJ Publishing Group Ltd.
BMJ Learning module: Swine flu - epidemiology - your questions answered (Thursday 15 October 2009): BMJ Learning users put questions to Professor John Edmunds and Dr Andrew Hayward on swine flu epidemiology. Recorded 12th October 2009. To take part in the next question and answer session, send your question to pandemic.podcast@bmjgroup.com
News: WHO will start delivering H1N1 vaccine to 100 poorer nations in November (Wednesday 14 October 2009): About 100 low and middle income nations will start receiving the first deliveries of H1N1 flu vaccines donated by drug companies and governments as early as November, World Health Organization officials announced on 12 October.
Blog: A lucky flu break (Tuesday 13 October 2009): England’s chief medical officer Sir Liam Donaldson can sound gloomy and pessimistic but he sounded very upbeat in this week’s swine flu update...
Mistaken identity: seasonal influenza versus influenza-like illness (Friday 09 October 2009): Evidence presented here points to influenza being a relatively rare cause of ILI and a relatively rare disease.
Editorial: The future of influenza vaccines (Thursday 08 October 2009): Vaccines may not be available in time, even in countries that have procured sufficient quantities. "To protect against seasonal and pandemic strains, vaccines and vaccine production need to improve," it concludes.
Research: Partial protection of seasonal trivalent inactivated vaccine against novel pandemic influenza A/H1N1 2009 (Thursday 08 October 2009): The 2008-9 seasonal flu vaccine provides some protection against pandemic influenza A/H1N1 2009, particularly the most severe forms of the disease, but seasonal vaccine should not replace vaccination against it, according to this case-control study in Mexico City.
Podcast: Vaccines - Q&A (Wednesday 07 October 2009): BMJ Learning users put questions to Professor Lyndsey Davies, Dr Jane Zuckerman and Professor Vivienne Nathanson on the UK swine flu vaccination programme. Recorded 1st October 2009. To take part in the next question and answer session, send your question to pandemic.podcast@bmjgroup.com.
News: People with asthma are most at risk of complications from swine flu, study shows (Tuesday 06 October 2009): The government has released further information on the underlying conditions that can cause swine flu to become more dangerous, showing that asthma is the most common comorbidity found in those who are admitted to hospital.
Feature: Flu's unexpected bonus (Saturday 19 September 2009): With over 96 countries stockpiling oseltamivir, Andrew Jack, pharmaceuticals correspondent with the Financial Times, assesses who has benefited from pandemic flu.
News: Chief medical officer warns that swine flu may be on the rise again (Friday 18 September 2009): The incidence of swine flu has risen in the past week in England, the first weekly increase in incidence since late July. Liam Donaldson, England’s chief medical officer, said that although the increase is slight, it may be "the start of an upturn."
Research: Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review (Wednesday 23 September 2009): Routine long term implementation of some of the measures to interrupt or reduce the spread of respiratory viruses might be difficult. However, many simple and low cost interventions reduce the transmission of epidemic respiratory viruses.
News: Children are likely to need two doses of swine flu vaccine (Friday 25 September 2009): Children are likely to need two doses of H1N1 influenza vaccine to achieve a full immune response, while most adults will need just one, the director of immunisation at the Department of Health has said
News: European agency approves swine flu vaccines for licensing (Tuesday 29 September 2009): Two swine flu vaccines, including one of those to be used in the United Kingdom’s vaccination programme, were approved for licensing by the European Medicines Agency on 25 September.
News: UN seeks $1.5bn and donations of vaccines to help poor nations fight swine flu (Tuesday 29 September 2009): United Nations health officials have called for rich nations to pledge more money and donate vaccines against H1N1 flu to help developing countries fight the pandemic.
BMJ Learning module: Swine flu - impact on secondary care (Friday 18 September 2009): Rodney Burnham, Chris Ellis and Bob Winter discuss the impact swine flu might have on secondary care with Helen Morant
BMJ Learning module: Swine flu vaccination - your questions answered (Wednesday 09 September 2009): Adam Finn, Tom Jefferson and Maureen Baker discuss issues surrounding vaccine development and safety with Zana Khan
doc2doc: GPs to be paid £100m for giving swine flu vaccine (Wednesday 16 September 2009): ... so reads a headline in today's Times newspaper following agreement between the Department of Health and the BMA's General Practice Committee that GPs in England are to be paid £5.25 for every dose of vaccine they administer.
News: Swine flu vaccine is a "thousandfold" safer than the infection, say experts (Wednesday 16 September 2009): Experts this week played down the risk of adverse effects from the forthcoming swine flu vaccine, saying that even in the worse case scenario people would be a "thousandfold better off" having the jab than the disease.
Clinical review: Recommendations for the administration of influenza vaccine in children allergic to egg (Tuesday 15 September 2009): Egg allergy affects about 2.6% of preschool children by 3 years of age, and influenza immunisation using egg based vaccines has been classified as a "relative contraindication" (prescribe with extra caution) in this patient group.
News: GPs are to be paid £5.25 a shot for swine flu vaccination (Tuesday 15 September 2009): GPs in England are to be paid £5.25 (5.90; $8.70) for every dose of swine flu vaccine they administer, once it is licensed, under a deal agreed between the BMA and the Department of Health.
News: Course of flu epidemic is hard to predict, says UK government adviser (Monday 14 September 2009): The second wave of swine flu is expected at the beginning of October at the earliest, the UK government’s chief scientific adviser has said.
News: China gears up for swine flu vaccination as virus spreads inland (Monday 14 September 2009): As China rolls out the first phase of its programme to vaccinate 65 million of its 1.3 billion people against A/H1N1 swine flu, the Ministry of Health has confirmed that the disease is spreading inland and into rural areas and may infect tens of millions of Chinese people in the coming months.
News: Mental health charities object to contingency plans for flu epidemic (Monday 14 September 2009): Mental health charities in the United Kingdom reacted with concern this week in response to government plans to relax mental health safeguards in the event of a worsening flu pandemic.
Should I have an H1N1 flu vaccination after Guillain-Barré syndrome? (Wednesday 09 September 2009): I have found myself asking the difficult question of whether to be vaccinated against H1N1 flu when I return to work as a hospital doctor this autumn. In December 2008 I developed severe Guillain-Barré syndrome but am making a good recovery.
Australia’s swine flu vaccination plans come under fire (Tuesday 08 September 2009): The Australian government’s impending programme of vaccination against H1N1 flu has been criticised by some professional groups that have raised concerns about potential risks.
Antiviral drugs: distinguish treatment from prophylaxis (Tuesday 08 September 2009): Shun-Shin and colleagues provide a timely review of the effectiveness of neuraminidase inhibitors for treatment and chemoprophylaxis of flu virus infections.
Tamiflu - the wrong message? (Friday 04 September 2009): In clinical trials on seasonal influenza, neuraminidase inhibitors (oseltamivir and zanamivir) have reduced transmission of influenza A but provided only modest symptomatic improvement.
Calibrated response to emerging infections (Friday 04 September 2009): The current flu pandemic raises a public health policy question: what is the proper response to clinically mild or epidemiologically limited (small number) outbreaks caused by new viruses?
Tamiflu - the wrong message? (Friday 04 September 2009): The widespread use of oseltamivir (Tamiflu) has been a key strategy in tackling the H1N1 "swine flu" pandemic in the UK. However, there have been growing concerns about the communication of this approach and rationale behind the policy itself.
Swine Flu - Your Questions Answered (Wednesday 02 September 2009): BMJ Learning Module: In this audio module, Cath McDermott, a clinical editor, puts a range of questions from health professionals to Kate Adams (a GP in Hackney, London), Matthew Thompson (a GP in Oxford and a clinical scientist at the Department of Primary Health Care at the University of Oxford) and Dean Marshall (Chairman of the Scottish General Practitioners Committee).
An Update on Antivirals (Wednesday 26 August 2009): BMJ Learning Module discussing practical issues related to prescribing antiviral treatments. Zana Khan, clinical editor at BMJ Learning speaks to Vanya Gant, consultant clinical microbiologist and member of the flu strategy steering group at University College Hospital London.
Planning for a pandemic - an up to date guide (Wednesday 20 May 2009): Module type: Read, reflect, respond Read and reflect on current issues; see what others think; and have your say.
Swine flu estimated to be 100 times more virulent than seasonal flu (Thursday 03 September 2009): PLOS Currents: Influenza is a journal with a difference. Mixing features of a journal with those of blogs and discussion forums it's bound to ruffle some feathers. It describes itself as "a moderated collection for rapid and open sharing of useful new scientific data, analyses, and ideas."
Opposition to swine flu vaccine seems to be growing worldwide (Tuesday 01 September 2009): As governments gear up to launch national vaccination programmes against swine flu, questions are beginning to emerge about how many people will be prepared to take up the offer of the vaccine.
Monitoring the emergence of community transmission of swine flu in England (Tuesday 01 September 2009): Comparing data from NHS Direct with laboratory data showed that local community transmission was happening once Health Protection Agency regional laboratories began detecting 100 or more influenza A/H1N1 2009 infections, or a proportion positive of over 20% of those tested, each week
The flu will be back after the break (Thursday 27 August 2009): Two swine flu call centres in England will close on Sunday with the loss of 1200 jobs reports the Guardian. Demand for Tamiflu has plummeted ...
Should healthcare workers have the swine flu vaccine? (Wednesday 26 August 2009): Evidence from decades of seasonal vaccination suggests likely benefits and low risk of adverse events
Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys (Wednesday 26 August 2009): The willingness to accept pre-pandemic influenza vaccination was low, and no significant effect was observed with the change in WHO alert level. Further studies are required to elucidate the root cause of the low intention to accept pre-pandemic vaccination.
A pandemic of pandemic news (Friday 14 August 2009): David Payne talks to Carl Heneghan and Matthew Thompson about media coverage of their BMJ paper on prescribing neuraminidase inhibitors for treatment and prophylaxis of influenza in children.
On swabs, tips, and a flu game (Tuesday 25 August 2009)
Incidence of swine flu in England continues to fall, but winter surge is predicted (Monday 24 August 2009): The number of new cases of A/H1N1 influenza reported in England continues to fall, but the government forecasts a sharp rise in cases during the winter months.
Pandemic flu: will there be a second wave? (Thursday 20 August 2009): Rates of swine flu are levelling off in the northern hemisphere as summer progresses. The question now is whether we’ll have a second wave this winter, and if so how bad it will be. Two
Tom Nolan on historic flu remedies (Thursday 20 August 2009): Last week we learnt who will be offered the vaccine against swine flu first. Priority groups include people in high risk groups age between 6 months and 65 years, pregnant women, household contacts of immune-compromised people, and clinical staff. But how many people will actually go and have the vaccine?
Syed Shah on being the first case of influenza A/H1N1 in the United Arab Emirates (Thursday 20 August 2009)
Pandemic lessons from Australia (Wednesday 19 August 2009): Pandemic flu hit Australia at the start of its peak flu season. Melissa Sweet looks at the virus’s effects and what the northern hemisphere can learn as its winter approaches
Figures, jabs, scaling back, and sewage (Friday 14 August 2009): The number of swine flu cases fell across the UK again, according to the weekly figures from the Health Protection Agency, although they caution their interpretation. Sir Liam Donaldson, England’s cheif medical officer, announced plans to scale back the pandemic flu service now cases are falling.
Carl Heneghan and Matthew Thompson on Tamiflu in children: what’s all the fuss (Friday 14 August 2009): The last few days has been hectic since the publication of our systematic review in the BMJ on the use of antivirals in children...
Is Tamiflu useful in children or not? (Tuesday 11 August 2009): Why did the operator at the National Pandemic Flu Service give the child Tamiflu? The cynics will say because the algorithm told him to, but the real answer, according to the UK government, is that it’s the safest thing to do to prevent severe infections.
Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials (Monday 10 August 2009): Research paper investigating how useful antiviral medications are in children.
Latest advice for GPs (Monday 10 August 2009): audio content form recent BMJ Learning module
Communicating with patients during the swine flu pandemic (Monday 10 August 2009): audio content from recent BMJ learning module
Telephone triage and the flu pandemic (Monday 10 August 2009): audio content from recent BMJ learning module
Swine flu: communicating with patients (Friday 07 August 2009): BMJ Learning module exploring issues GPs face when discussing swine flu with patients.
Officials watch events in southern hemisphere as swine flu rates in UK slow down (Friday 07 August 2009)
The calm, waves of flu, vaccines, and other stories (Friday 07 August 2009): Calm settled over swine flu coverage this week as the northern hemisphere headed into the summer holidays; but much remains uncertain.
HPA advice on antipyretics contradicts NICE guideline (Friday 07 August 2009): Julius Wagner-Jauregg won the Nobel prize in 1927 for developing an effective treatment for syphilis which entailed deliberately infecting patients with malaria.
Time for case-control studies of NSAIDs and oseltamivir (Friday 07 August 2009): Hama highlights our ignorance about the harmful effects of oseltamivir (Tamiflu) and the non-steroidal anti-inflammatory drugs (NSAIDs) commonly used in flu.
How much flu is out there? (Tuesday 04 August 2009): The Health Protection Agency estimates that there were 110,000 new cases of swine flu in England last week,10,000 more than the week before. But how did they work this out and how accurate is it?
Side effects, Tamiflu, and the swine flu hotline (Friday 31 July 2009): A hundred and five thousand people with flu symptoms were prescribed Tamiflu via the new hotline last week. But there are some unintended consequences.
Swine flu incidence in England is slowing down (Monday 03 August 2009): The signs are that the weekly number of new infections of A/H1N1 flu is beginning to level off, the Department of Health for England has said.
Pregnancy and swine flu: (Monday 27 July 2009): If you’re pregnant lock yourself in the house, shut the curtains and wear a facemask if you so much as put your nose outside the door… has advice to pregnant women finally gone too far?
Doctors call for guidance on how to prioritise critically ill patients in swine flu pandemic (Thursday 30 July 2009): "Extraordinary pressure" is expected on critical care beds this autumn, as the A/H1N1 influenza pandemic is set to enter a severe phase. However, the Department of Health has yet to clarify how it plans to meet demand, according to a House of Lords report this week.
Collection point nonsense (Thursday 30 July 2009): Talk of swine flu seems to have died down considerably since the launch of the national flu pandemic service in England last week. Despite the lack of news generally, it’s no longer on the front page of every newspaper - perhaps due to the telling off that the media got at the weekend (see Monday’s blog).
Critical care and the pandemic panic (Monday 27 July 2009): A “panic pandemic” is worsening the crisis in the UK said health ministers over the weekend. Andy Burnham, the health secretary, told The Observer of the need for people to keep a sense of perspective.
Swine flu: an update from the HPA (Friday 24 July 2009): The HPA has a key role in the coordination of the UK's response to a pandemic, and continues to be the key point of contact for surveillance. This audio module tells you how they are doing this. The module gives the most recent advice in light of the current stage of the pandemic.
Swine flu website inundated as cases in England double in a week (Friday 24 July 2009): The Department of Health for England said that the number of cases of influenza A/H1N1 has almost doubled, increasing to 100 000, from about 55 000 a week ago.
A/H1N1 influenza virus: the basics (Friday 24 July 2009): Do you know your H1N1s from your H2N2s? Geoff Watts explains the basic science of the influenza virus
Sneeze and Click service launched in England (Friday 24 July 2009): Last week 100,000 people are estimated to have had swine flu in the UK. 840 are in hospital and 63 are in intensive care according to Chief Medical Officer Sir Liam Donaldson. The number of deaths has climbed to 26, while worldwide 700 are thought to have died.
EU prepares new guidelines for monitoring swine flu (Friday 24 July 2009): The European Centre for Disease Prevention and Control is planning to issue new surveillance advice to national health authorities on the A/H1N1 influenza pandemic.
Confusion over flu advice in pregnancy (Monday 20 July 2009): A storm erupted over the weekend about the government’s advice to pregnant women on swine flu.
Prescribing antivirals - is beyond 48 hours too late? (Wednesday 22 July 2009): After Monday’s statement to the House of Commons from Andy Burnham (you can watch all ten hours of the commons session here), the RCGP emailed members to summarise this and other developments.
Feeling the strain of swine (Thursday 16 July 2009): New cases of swine flu went up by 42% in England last week according to new figures from the Royal College of General Practitioners.
Celebrity swine watch (Monday 13 July 2009): The first UK swine flu death in a person without underlying health problems was reported on Friday. According to today’s Daily Mail, the man was “admitted to Basildon Hospital in Essex on July 1 and was placed in isolation in the intensive care unit.” The death has been referred for a post-mortem. In the United States, the government is encouraging the public to help in the fight against swine flu.
Swine flu forecast (Friday 17 July 2009): Yesterday was a busy day for swine flu in the UK. First we learnt that 65,000 people could die from it in the UK if the government’s worst case scenario predictions come true. That’s three times more than the excess deaths during the 1999/2000 winter flu season and double the number in the two previous global pandemics in 1957-8 and 1968-9.
How do you monitor swine flu? (Friday 10 July 2009): Yesterday, reporters descended on Whitehall to hear about the methods of influenza monitoring. Sir Liam Donaldson, the Chief Medical Officer led the numbers feast alongside Justin McCracken, chief executive of the Health Protection Agency, and Ian Dalton, the new flu czar.
Are swine flu parties an urban myth? (Thursday 09 July 2009): Swine flu parties are the hottest ticket in town. Everyone’s been talking about them yet no-one seems to know anyone who’s been to one. Peter Flegg, a physician in Blackpool, is suspicious.
H1N1, the science bit (Tuesday 07 July 2009): Yesterday the number of deaths in the UK rose to seven. So far all of those who have died with H1N1 in the UK have had serious underlying health conditions and little information has been released about whether these people have died with H1N1 or because of it.
Partners in swine (Friday 03 July 2009): Yesterday I attended the Department of Health briefing on swine flu where the suave new secretary of state for health, Andy Burnham, and his partner in swine, Sir Liam Donaldson, gave an update.
Swine flu vaccines and swine tig (Monday 06 July 2009): Vaccination plans for the UK are slowly beginning to emerge. On Thursday Sir Liam Donaldson confirmed that 60 million vaccines are scheduled to be produced by the end of the year with the first batches ready for administration within the next month. The two different vaccines (one made by Baxter, the other by GSK) each come in two doses to be given three weeks apart.
Joe Collier on manoeuvres for avoiding Mexican flu (Wednesday 06 May 2009): Mexican (swine) flu is clearly a threat. It is difficult to know exactly how best to avoid being infected, and although the risks for a Londoner are remote here are some changes I now make in my day-to-day life in an attempt to stave contagion off.
Was H1N1 leaked from a laboratory? (Thursday 02 July 2009): 391 cases of H1N1 were confirmed in the UK yesterday bringing the total number of confirmed cases to 6929. In Argentina, the state of Buenos Aires has declared a health emergency, with schools closing for their winter breaks early - the city’s mayor has called for families not to “treat this as extra holidays for the kids” and more of a “time for the children to stay at home as much as possible”. Meanwhile Australia now has 4568 confirmed cases (198 more yesterday) and 9 deaths.
Come swine with me (Wednesday 01 July 2009): My plans for a H1N1 themed dinner party “come swine with me” are in tatters after Dr Jarvis, chairman of the British Medical Association’s public health committee, yesterday declared swine flu parties not to be a good idea. Apparently it will threaten to undo all the good work that’s been done to contain the outbreak.
The spread of swine flu (Monday 29 June 2009): “We’re saying there have been at least a million cases of this new H1N1 virus in the United States so far this year. “ That’s according to the Centers for Disease Control and Prevention (CDC) which held a press conference on Friday which shed some more light on the epidemiology and spread of the disease.
Too early to say mild (Tuesday 30 June 2009): The number of laboratory confirmed cases of swine flu in England has shot up by nearly fifty percent since last Friday. 1604 new cases were confirmed between 27-29th June, bringing the total number to 4968.
"You can’t have swine flu" (Friday 24 July 2009): "Never assume" is a good maxim for life in general, but it seems particularly apt as we try to get to grips with the first major new disease to hit us for some time.
Who wants to be the flu doctor? (Friday 24 July 2009): A couple of weeks ago, some GPs contacted a clinical ethics committee. They cited guidance issued by the Royal College of General Practitioners, the BMA, and the Department of Health: "Every GP practice must identify the person in the practice who will act as the practice lead on flu pandemic issues."
How well is the UK managing the influenza A/H1N1 pandemic? (Friday 24 July 2009): Pretty well, and it has served as an important rehearsal for a more lethal pandemic, says Roy Anderson
A/H1N1 influenza update (Thursday 23 July 2009): As the English government launches a dedicated telephone service and website that will prescribe antivirals to take the pressure off of GPs, Adrian O’Dowd reports on the latest information on swine flu
BMJ.com blog: Jane Parry on Flu (Monday 20 April 2009): Hong Kongers have lived through more than their fair share of bird flu scares across the border in China over the last few years, and, of course, Sars in 2003 when 299 people in the city died of the disease. Then there was the cull of Hong Kong’s entire poultry population back in 1997. It’s not surprising, then that 7 million residents of this crowded city are a little twitchy about pandemic flu threats.
Government tries to end confusion over swine flu advice to pregnant women (Wednesday 22 July 2009): The government has issued new guidance to try to end the confusion over advice to pregnant women on how to avoid the A/H1N1 virus.
England to launch special flu service next week to take pressure off primary care (Monday 20 July 2009): The Department of Health for England has brought forward by three months its plans for a national pandemic flu service to relieve pressure on GPs and other NHS service providers as the number of cases of influenzaA/H1N1 and consultations continue to rise rapidly. The service, which will launch towards the end of the week, means that people will be able to get a prescription for antiviral drugs through a special telephone and internet service rather than by visiting or telephoning their GP.
Data on flu deaths are potentially misleading, say researchers (Wednesday 15 July 2009): The only thing that can definitely be said about the A/H1N1 flu outbreak is that the virus is not becoming more virulent, said epidemiologists this week.
GPs will lead UK’s swine flu vaccination campaign (Wednesday 15 July 2009): The government is planning a large scale but non-compulsory campaign of vaccination against the A/H1N1 virus.
Healthcare workers should get top priority for vaccination against A/H1N1 flu, WHO says (Wednesday 15 July 2009): The World Health Organization said on Monday 13 July that healthcare workers in all countries should be vaccinated against the A/H1N1 flu virus "as a first priority." They should be followed by high risk groups such as people with chronic conditions and pregnant women.
Assessing the severity of the novel influenza A/H1N1 pandemic (Wednesday 15 July 2009): A major concern about the emergence of the novel strain of influenza A/H1N1 is the severity of illness it causes. Tini Garske and colleagues propose methods to obtain accurate estimates of the case fatality ratio as the pandemic unfolds
Patients and doctors are asked to report antivirals’ side effects as swine flu spreads (Monday 13 July 2009): The number of people in the United Kingdom confirmed as having died after contracting the A/H1N1 virus rose to seven this week after the deaths of three more people, including two children, were announced. All were said to have had serious underlying health problems.
Cases of A/H1N1 flu are nearing epidemic levels in London and West Midlands, say GPs (Monday 13 July 2009): London and the West Midlands are approaching epidemic consultation rates for A/H1N1 influenza, figures from the Royal College of General Practitioners show. Epidemic activity can be defined as 200 consultations with patients with influenza-like illness per 100 000 people per week.
WHO to call on nations with high rates of swine flu to move away from testing all suspected cases (Thursday 09 July 2009): The World Health Organization said on Tuesday (7 July) that with the A/H1N1 influenza pandemic evolving rapidly, it plans to issue new guidelines for nations with large infection rates, advising them to move away from conducting laboratory testing on all suspected cases and to focus instead on monitoring big trends in the spread of disease.
Policy on antiviral drugs needs to be revised … (Wednesday 08 July 2009): UK swine flu policy recommends antiviral agents for febrile patients with two or more symptoms of flu-like illness, up to seven days from onset.1 Thus, even with comparatively low rates of flu-like illness, many people are prescribed antiviral agents.
… as does policy on antibiotics (Wednesday 08 July 2009): The Department of Health recently published a pathway for the hospital management of adults with swine flu.1 2 We have serious reservations about the antibiotic recommendations.
Call for flu research under way (Wednesday 08 July 2009): The National Institute for Health Research (NIHR), in coordination with the Medical Research Council and Wellcome, is currently commissioning research studies as part of the national response to the emerging flu pandemic.
Who should receive Tamiflu for swine flu? (Tuesday 07 July 2009): People with severe disease or risk factors, until the population is vaccinated
UK government predicts 100 000 new A/H1N1 flu cases a day by September (Friday 03 July 2009): The UK government is planning for a rapid rise in the number of cases of A/H1N1 flu and is limiting provision of antiviral drugs to people with symptoms, while excluding asymptomatic contacts of infected people. The move comes after the revelation that up to 100 000 new cases of the infection could emerge each day by the end of August.
Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak (Friday 03 July 2009): Objective: To assess whether perceptions of the swine flu outbreak predicted changes in behaviour among members of the public in England, Scotland, and Wales.
Who wants to be the flu doctor? (Thursday 02 July 2009): In 1841 the William Brown struck an iceberg in the North Atlantic. The doomed ship sank with 31 passengers. The remaining passengers scrambled onto lifeboats. In one of the lifeboats, the 41 escapees were so heavy that the first mate feared that the boat would sink. He instructed his eight crewmen to "go to work, or we shall all perish." Sixteen passengers were thrown overboard.
Two more people in UK die from swine flu, as swabbing policy ends in “hot spot” areas (Wednesday 01 July 2009): Two more people have died in the United Kingdom after contracting the A/H1N1 virus, while some GPs in so called hot spot areas are now handling the virus in a different way from how they did at the start of the epidemic.
Tom Nolan chooses his own swine flu adventure (Friday 26 June 2009): The pandemic continues to spread throughout all corners of the world, with Serbia and Iraq getting their first cases yesterday. In the UK the West Midlands still lead the way in new cases with 115 confirmed there yesterday.
Use of Tamiflu may need to be rethought as number of swine flu cases in the UK nears 3000 (Friday 26 June 2009): The United Kingdom may need to rethink its strategy on use of the antiviral drug oseltamivir (Tamiflu) to treat swine flu, a BMA official has said, as the UK’s number of cases is rising faster than in most of the rest of the world.
Tom Nolan’s flu blog (Thursday 25 June 2009): The media’s interest in H1N1 may have declined, but the number of cases appears to be on the increase, and not just in the southern hemisphere where we’re told to look to. The World Health Organisation’s latest map of H1N1 cases gives an interesting if simplistic snapshot of the most affected areas globally.
Annabel Ferriman on questions for Margaret Chan (Monday 22 June 2009): The spread of A/H1N1 flu has propelled Margaret Chan, director general of the World Health Organization, into the limelight. On 11 June she was on television and radio programmes across the world, declaring that “the world is now at the start of the 2009 influenza pandemic” and that “further spread is considered inevitable”
Swine flu comes home: a GP’s tale (Monday 22 June 2009): So there we were, early Wednesday afternoon, preparations under way for the evening surgeries, when the phones started to ring off the hook. Almost simultaneously we got an email from the PCT telling us that 143 children from the local primary and infant schools were sick with an as yet unidentified viral illness.
Swine influenza: an update on recent developments (Friday 19 June 2009): Module type: Read, reflect, respond Read and reflect on current issues; see what others think; and have your say.
Swine flu fear and loathing in Mexico…and London (Tuesday 16 June 2009): My flight to Cancun, Mexico, to attend the Conference of the Academy for Eating Disorders (AED) was scheduled for Sunday, 26th of April. The day before there were several anxious emails about the swine flu outbreak in Mexico City, but a reassuring response from the AED president followed: of course the conference would go ahead.
Australia plans to restrict antiretrovirals to high risk cases as swine flu spreads (Tuesday 16 June 2009): Health authorities in Australia are bracing for a fraught winter, as the novel H1N1 influenza A virus spreads alongside seasonal flu.
World Health Organization declares A (H1N1) influenza pandemic (Friday 12 June 2009): The head of the World Health Organization has declared the first influenza pandemic in 41 years after intense consultations with top officials from countries that are experiencing rapid transmission of the novel A (H1N1) flu virus at the community level, and with international experts monitoring the global outbreak.
Monitoring public anxiety about flu, Keith J Petrie and Kate Faasse (Thursday 11 June 2009): Greater monitoring of the web could provide a guide to public anxiety about flu outbreaks and social media could be used more intensively to provide relevant public health information to younger groups.
UK scientific adviser criticises UK planning for flu pandemic (Tuesday 09 June 2009): The government’s chief scientific adviser is not convinced that the United Kingdom has the right plans in place to cope with avian flu.
Countries hit by swine flu reach 62 (Wednesday 03 June 2009): Countries hit by swine flu reach 62: The number of countries affected by the A/H1N1 flu virus has risen to 62, according to the World Health Organization. Globally, as the BMJ went to press, there were 17 459 confirmed cases of the virus in 62 countries, including 115 deaths. The UK figure has risen to 278.
Time to rethink the UK’s response to swine flu? (Wednesday 27 May 2009): As a general practitioner practising in south London and the mother of a son confirmed with swine flu in early May, I have found that advice about swine flu is inconsistent across the UK.
Swine flu planning (Tuesday 26 May 2009): In this podcast we look at planning for a pandemic (this is particularly applicable for GPs in the UK). Helen Morant talks to Maureen Baker, honorary secretary of the Royal College of General Practitioners, and Kate Adams, a GP in East London, about what’s been done to help the country prepare for a ‘flu outbreak.
Number of confirmed swine flu cases could be “tip of iceberg” (Tuesday 26 May 2009): Almost 13 000 people around the world have now been confirmed as having been infected with the A/H1N1 flu virus, but experts in the United States are warning that the actual figures there could be much higher.
UK urges more flexibility in criteria for flu pandemic alerts (Thursday 21 May 2009): Greater flexibility and additional information are needed when deciding whether to declare a flu pandemic, a delegation of countries have told the World Health Organization.
The problem with flu vaccines (Thursday 21 May 2009): With the number of cases of swine flu continuing to rise, Andrew Jack assesses our capability to produce enough vaccine to cope with a pandemic
Governments must be pulled up for failings over flu (Friday 15 May 2009): The escalating A/H1N1 flu outbreak has led to cracks in the system of international coordination based on evidence. Governments and the World Health Organisation alike should be held accountable.
Swine flu: Ethical implications (Thursday 14 May 2009): Dr Tony Calland, chair of the BMA medical ethics committee and a recently retired GP, and Dr Andrew Hartle, chair of Imperial College Healthcare NHS trust Clinical Ethics Committee and an anaesthetics consultant at St Marys’s hospital in London, discuss the ethical dilemmas that doctors are likely to face as a pandemic worsens.
Pandemic Flu - an update on ethical dilemas (Tuesday 12 May 2009): Module type: Read, reflect, respond Read and reflect on current issues; see what others think; and have your say.
Mexico City returns to normality, but cases of A/H1N1 reach almost 2000 in US (Monday 11 May 2009): Mexico City’s 20 million residents emerged last week from a five day economic shutdown that the authorities had ordered to try to contain the A/H1N1 flu epidemic. Offices and restaurants have reopened, and high school and university students have gone back to class.
Swine flu, the definitive guide (Monday 11 May 2009): Confused about swine flu? Worried about how best to protect yourself and your loved ones? Read the definitive guide from the BMJ group.
Chief medical officer warns against complacency over swine flu (Friday 08 May 2009): The health secretary, Alan Johnson, and the chief medical officer for England, Liam Donaldson, have told the public not to become complacent about A/H1N1 flu and have warned that the hallmarks of a pandemic are still present.
Warning against buying flu drugs online (Friday 08 May 2009): Drugs being sold as treatments for swine flu by unauthorised internet suppliers could be hazardous to health, the UK drug-safety watchdog has warned. It says there is a risk that drugs not supplied by a registered pharmacy could be substandard or counterfeit.
A/H1N1 influenza: questions and answers (Thursday 07 May 2009): The pandemic alert level has been raised to phase 5—just one level short of a full pandemic—by the World Health Organization. As influenza A/H1N1 spreads quickly from its origins in Mexico, Rebecca Coombes assesses the threat and our levels of protection
About the BMJ Pandemic Flu blog (Thursday 07 May 2009): The BMJ Group is publishing a lot of about Pandemic flu - not just news items, but blogs, podcasts, learning modules, Best Practice monographs and features. We are going to post on this blog when each new item is published. Keep checking back for the latest news, as the situation changes.
Global aid agencies boost support to poorer nations to fight flu threat (Wednesday 06 May 2009): International agencies, spearheaded by the World Health Organization, are scaling up their support to low and middle income nations, including Mexico, to help them respond to the possible threat of an A/H1N1 flu pandemic.
Mairi Scott and Tom Love on pandemic flu training for retired health care professionals (Wednesday 06 May 2009): Pressures on the workforce are going to be one of the big challenges for the NHS in a pandemic. One strategy which might help with this problem is to draw upon retired health professionals, who could fulfil a number of possible roles.
Influenza pandemics: why, what, and how to prepare (Tuesday 05 May 2009): Module type: Just in time Want a fast, evidence based update? Here are the essentials on everyday conditions.
European flu toll reaches 107 confirmed cases (Tuesday 05 May 2009): By the morning of Tuesday 5 May, when the BMJ went to press, 107 confirmed and 10 probable cases of A/H1N1 flu had been reported in the European Union, said the Stockholm based European Centre for Disease Prevention and Control (ECDC).
Mass information campaign starts in UK as flu cases rise to 28 (Tuesday 05 May 2009): A mass public information campaign starts in the United Kingdom this week as leaflets on how to stop the spread of swine flu begin to arrive in every home.
Swine flu - HPA special (Tuesday 05 May 2009): Helen Morant asks Anthony Kessel, director of public health strategy at the Health Protection Agency, about the role of the HPA in managing pandemic influenza.
Personal View: The flu epidemic in Mexico: the challenges for doctors (Tuesday 05 May 2009): The statistics usually reported in epidemics are morbidity and mortality, together with the economic costs. However, the consequences of epidemics are much wider, affecting the very roots of society and modifying doctors’ practice.
doc2doc blog: Carlos Cuello’s updates from Mexico (Saturday 02 May 2009)
BestPractice monograph: Swine influenza (Friday 01 May 2009): Swine influenza is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza viruses. The H1N1 subtype of influenza A virus is the most common, but other subtypes do circulate in pigs (e.g., H1N2, H3N1, H3N2). The 2009 outbreak is caused by a strain of the H1N1 subtype. Swine influenza has not normally infected humans, but the 2009 strain is transmitted through humans.
BMJ Learning audio module: Swine influenza: an update (Friday 01 May 2009): Module type: Read, reflect, respond Read and reflect on current issues; see what others think; and have your say.
News: US Congress holds hearings on outbreak of influenza A (H1N1) (Friday 01 May 2009): Questions on the threat posed by the outbreak of influenza A (H1N1) remained unanswered after three days of congressional hearings in Washington, DC. But the meetings dampened down media frenzy through the constant repetition of the limited facts that were known.
News:EU commissioner says pandemic likely, but may not be deadly (Friday 01 May 2009): European Union governments will increase cooperation among themselves in the fight against the novel flu virus but have not committed themselves to sharing their stockpiles of vaccines and antiflu drugs.
News: Confirmation of first person to person transmission of swine flu in UK expected soon (Friday 01 May 2009): The first human to human transmission of swine influenza in the United Kingdom is expected to be confirmed today, as the number of confirmed cases has risen to eight.
Podcast: Financial incentives and potential pandemic (Friday 01 May 2009): This week Helen Morant talks to Richard Coker from the London School of Hygiene and Tom Jefferson from the Cochrane Vaccines Field about pandemic flu. Geoff Watts talks to Theresa Marteau from the Institute of Psychiatry about the Wellcome Trust’s new Centre for the Study of Incentives in Health. And Annabel Ferriman takes us though this week’s news.
Patient information: Wash your hands to protect against flu (Friday 01 May 2009): Patient information from BMJ Best treatments, published in the Guardian
Blog post: case reports on pandemic flu (Wednesday 29 April 2009): It is great to see that the whole world is discussing case reports! Led by the World Health Organisation we are constantly being kept up to date with a growing case series of swine influenza.
Research: Physical interventions to interrupt or reduce the spread of respiratory viruses (Tuesday 27 November 2007): To systematically review evidence for the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses.
Editorial: UK preparedness for pandemic influenza (Saturday 12 May 2007): Devolving responsibility for implementation to local authorities may not be the best policy
Editorial: Preparing for the next flu pandemic (Saturday 10 February 2007): New clinical guidelines focus on coordinating services and standardising care
News: WHO raises flu pandemic alert to level 5 (Thursday 30 April 2009): The World Health Organization has raised its flu pandemic alert level to five, the second highest level, saying it thinks that a global outbreak of swine influenza is imminent.
Editorial: Swine Flu (Thursday 30 April 2009): Fragile health systems will make surveillance and mitigation a challenge
BMJ.com blog: BM Hedge on Flu (Thursday 30 April 2009): I was working in Ipswich in a cardiothoracic centre during the 1968-69 ‘Flu epidemic. During the Xmas week end of 1968 I had to be on call from Friday through Monday morning as most of my colleagues were on leave. I had to certify more than 50 deaths, mostly in the geriatric age group. Elderly patients with cardiac and respiratory co-morbidities used to come down with ‘Flu and die within hours of admission.
BMJ.com blog: Adrian Gonzalez on swine flu in Mexico (Thursday 30 April 2009): In 2003 I was at the BMJ’s offices in Tavistock Square, London, when China’s SARS (severe acute respiratory syndrome) epidemic was at its peak. At that time the risk of infection seemed far away. Today is different; I’m living and working in Tlalpan, the district of Mexico City that holds the largest concentration of hospitals and healthcare professionals.
News: Health department starts to stockpile masks for clinicians to combat swine flu (Wednesday 29 April 2009): The Department of Health is planning to stockpile huge numbers of extra facemasks for clinicians to use in preparation for a possible pandemic of swine influenza.
News: Swine flu could come back in more virulent form after summer (Wednesday 29 April 2009): The number of deaths in Mexico from swine influenza may be only "the tip of the iceberg" and, after a mild summer, the virus could return in a more virulent form, experts at the Stockholm based European Centre for Disease Prevention and Control said this week.
Patient information: Swine flu - what should you do? (Monday 27 April 2009): Patient information from BMJ Best treatments, published in the Guardian
Article: Ten things your emergency department should consider to prepare for pandemic influenza (Wednesday 22 April 2009): Original article from the Emergency Medicine Journal

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