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Archives for September 2009

Swine flu vaccines get first UK trial

Fergus Walsh | 22:23 UK time, Monday, 28 September 2009

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Researchers in Oxford have .

Swine flu vaccineWorking with teams in Bristol, Exeter, Southampton and London, they are aiming to recruit 1,000 youngsters aged six months to 12 years. I went to the Children's Hospital at the John Radcliffe in Oxford to witness what were the first recipients of the UK's H1N1 vaccines.

Although both vaccines are likely to get licensed in the next few weeks, none of the trials has taken place in Britain. Pandemrix (made by GSK) was approved by the European Medicines Agency on Friday, while Baxter's H1N1 jab seems likely to get approved this week.

This is the first time the vaccines have been used in the UK and the first comparative study of the jabs.

Andrew PollardProfessor Andrew Pollard from the University of Oxford is heading the research:

"We are doing this trial to compare head-to-head the two vaccines which are going to be used in the UK against swine flu to see which one works best in children and which one is best tolerated. We are sort of in a race against time because we know the flu season is already started. We hope to immunise the children over the next 10 days or so. There are very few exclusions - people with immune system problems and egg-allergic children because one of the vaccines is made using egg."

The GSK vaccine is made using the traditional means of growing the virus in embryonated hens' eggs, before the virus is broken and deactivated. The Baxter vaccine is made in cell culture, so is suitable for those who have an egg allergy. Among the expected side-effects are sore arms and fevers. The information given to parents also lists rare side-effects including Guillian-Barré syndrome, which can cause ascending paralysis and even be fatal.

It's worth quoting here from the trial information:

"Other very rare events that have been seen with routine flu vaccines include seizures and temporary bleeding disorders. In the past Guillian-Barré syndrome (a rare disorder of nerves) has been associated with flu vaccines but the relationship remains uncertain, with some studies suggesting a possible link but others not finding it. One large study in the UK found that influenza-like illness itself was associated with an increased risk of the Guillian-Barré syndrome but there was no link with the seasonal influenza vaccines, suggesting that vaccination might actually protect against the disorder by preventing flu."

What I take that to mean is that, if you have the vaccine, there is a remote, theoretical possibility that you could get GBS (as happened in the USA in 1976 with their swine flu vaccine), but you are more likely to get it as a result of contracting flu. So while it is impossible to rule out the risk of GBS from the vaccine, it is very remote, and this must be balanced against the very real and proven risks of complications from flu.

I spoke to several of the parents and asked them why they had brought their children along. Considering it was the first day of the trial, it was not surprising to find several doctors who had heard about the trial.

Dr Jocelyn Hughes is an Oxford paediatrician. She brought four-year-old Susanna and two-year-old Ben to be immunised.

"I was keen to offer Susanna and Ben some protection against swine flu having seen some cases in A&E, and having the trial on our doorstep was a good way of doing that."

Nicolette WolfNicolette Wolf brought 17-month-old Reuben to be immunised. She is pregnant and will be one of the first to be offered a swine flu jab. I wondered whether she would take it, because, in researching the Panorama on swine flu, we met several pregnant women who seemed not keen on having the jab. Nicolette feels differently:

"I will definitely take it to protect myself and obviously the baby. I know my immunity is low as a pregnant woman. I had a cold recently that really hit me and I was shocked to see how long it took to recover - so all the more reason to have the swine flu jab."

Graunya Bean and LiamGraunya Bean brought four-year-old Liam.

"My youngest son Logan got swine flu three months ago and was really ill. He had an extreme high temperature and was refusing fluids. We had three days of being very concerned about him until he got Tamiflu. Liam has just started school and quite a few kids have come down with it there so we were concerned about him getting it, and obviously there's the benefit of them being able to do research to help others."

This clinical trial comes just a month before a UK immunisation campaign begins. More than 11 million people in Britain considered to be most at-risk from flu, such as those with asthma or heart problems, will be offered the vaccine plus more than two million front-line health workers.

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Above you can see a brief interview with Andrew Pollard and one of the families on the trial.

Vaccines for swine flu

Fergus Walsh | 16:30 UK time, Friday, 25 September 2009

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Plans to vaccinate millions of people in Britain against H1N1 swine flu have taken a step forward today. The European Medicines Agency (EMEA) .

A licence won't be granted until it's been approved by the European Commission, but that is expected in the next couple of weeks. GSK is one of two suppliers of pandemic vaccine to the UK, the other being Baxter. But its vaccine did not get approved today. The EMEA said that there had been an issue about the quality of the vaccine, but that they hoped to resolve that next week. The Baxter vaccine is not made using eggs, so it will be useful for those rare people with an anaphylactic reaction to egg.

The UK has contracts for up to 132 million doses of pandemic vaccine - enough for everyone in Britain to receive two shots. But early data suggests one jab may be sufficient. This is what the EMEA had to say on this:

"The Committee is currently recommending a two-dose vaccination schedule, at an interval of three weeks, for adults, including pregnant women, and children from six months of age. The Committee acknowledged that there are preliminary data suggesting that one dose may be sufficient in adults. The Agency is expecting further data from ongoing clinical studies over the coming months and these recommendations may be updated."

It should mean that Britain is on track to begin begin an immunisation campaign next month. Just a reminder of . Here's the list, in order of priority:

• individuals aged six months and up to 65 years in the current seasonal flu vaccine clinical at-risk groups
• all pregnant women, subject to licensing considerations on trimesters
• household contacts of immunocompromised individuals
• people aged 65 and over in the current seasonal flu vaccine clinical at-risk groups

So how many people will that involve? Getting figures for the whole of the UK means contacting four separate health departments, which is why very often, you will see only the figure for England. My understanding is that the total is 11.45 million people for the UK (9m England; 1.3m Scotland; 0.75m Wales; 0.4m Northern Ireland). In addition, more than two million frontline health workers will be immunised in tandem with the above groups.

The government now has an agreement with GPs to vaccinate the at-risk groups. But this will take a huge amount of organisation, especially since the seasonal flu campaign will continue.

There are many questions which arise from the planned immunisation campaign, not least how big the uptake will be. NHS staff members have a very poor record of taking the seasonal flu jab, with only 16% uptake.

Many pregnant women may also be loath to have the jab and rather hope for the best that they don't get the virus, and that if they do, get it mildly. Pregnant women are at elevated risk of both catching swine flu and getting complications. In order to carry a child through pregnancy, the body's immune system is naturally suppressed.

The first person to die from complications of swine flu in June was a 38-year-old woman in Scotland who'd given birth prematurely. She had underlying health conditions. And ? She got swine flu when six months pregnant and had to be flown to Sweden for specialist treatment. Fortunately, she is now recovered and her baby is due next month.

Both of those cases are extreme examples. The vast majority of pregnant women who catch swine flu will have a mild infection. But the expert advice is that they should be immunised. What is not clear yet is how early in the pregnancy it will be recommended and whether or whether it will be restricted to women who are in the second and third trimesters (that is, from three months onwards).

The final recommendation on timing rests with the Joint Committee on Vaccination and Immunisation (a sort of for vaccines). I've been looking at and it gives an idea of what they are thinking on this:

"The committee supported the use of either vaccine once licensed in pregnant women. The committee noted that many women are advised not to take any kind of drug in their first trimester unless recommended by a medical practitioner. The committee advised that all pregnant women, including those in their first trimester, could receive the vaccine. Both swine flu vaccines are inactivated and there is no evidence that the foetus is at any risk when the mother is immunised with an inactivated vaccine such as the seasonal flu vaccine. Seasonal flu vaccines have been used for a number of years in the US with no evidence of harm. The committee noted that vaccinating pregnant women would not only provide benefit to them but also provide benefit to the infant, when born, through vertical transfer of maternal antibodies."

The JCVI also sees no reason why you can't have your pandemic flu jab at the same time as a seasonal flu vaccine. This is what they had to say on that:

"The committee advised that since the swine influenza vaccines are inactivated, they could be co-administered with all other vaccines including seasonal influenza and childhood vaccines. Vaccines should be given at separate sites, preferably in different limbs. If given in the same limb, they should be given at least 2.5 cm apart."

So what will the government do with all those extra vaccines, once the at-risk groups are immunised? My hunch is that they may decide to offer the jab to all children, not just to those who are at risk of complications. But that decision does not need to be taken now, and instead officials will wait to see how the virus behaves in the months ahead.

Weekly briefing: Cases rising

Fergus Walsh | 13:39 UK time, Friday, 18 September 2009

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The children are back at school and the weather is turning colder, so it's no surprise that .

At his weekly briefing, the chief medical officer for England, Sir Liam Donaldson, said:

"We might be seeing the start of an upturn. There are straws in the wind, from the increase in consultations with GPs and a small increase in hospitalisations. It suggests swine flu is coming back."
The estimated number of cases in England rose last week from 3,000 to 5,000. In Scotland, cases also rose sharply to around 6,000. There were small rises in Northern Ireland and Wales.


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So swine flu is back. It never, of course went away. It's worth remembering that in one week in July, there were more than 100,000 cases. It seems likely that we are at the start of the next upturn. There have been outbreaks in several schools, but it's unlikely that schools will close because the virus is so entrenched in the community.

It bears repeating that the vast majority of people who get infected will get a mild illness. Very few people die from H1N1 swine flu, although it does cause complications in a minority. On the morning of 16 September, there were 143 people in hospital in England with swine flu, of whom 23 are in critical care.

So far, 79 people have died after contracting the virus, far lower than the number of those who die from seasonal flu (anything from 4,000-12,000 in a normal year). The difference is that swine flu is targeting younger age groups whereas seasonal flu usually kills the frail elderly. About one in five of the deaths from swine flu has been in previously entirely healthy people.

CMO briefing

This is an important graph, because it allows us to put the outbreak in context. If you look at the red line, you can see that we have already had one big peak of swine flu in July, but it never reached epidemic levels. The last epidemic was in 1999-2000. What we all want to know is what will happen to that red line next. At some point this autumn or winter, we should expect the red line to rise much higher than the 1999-2000 peak, so there's a long way to go.

CMO briefing

There's now a race on to get the pandemic flu vaccine ready and licensed before the next big peak of infection. This next graph shows, in order of priority, the groups who will receive the pandemic H1N1 vaccine. I think these figures might be England only, and will try to get you a UK-wide total.

You can see that the first to be immunised will be nearly five million people aged six months to 65 years who are considered at risk from flu. Pregnant women are at increased risk because their immune system is naturally suppressed. What's not clear is at what point in pregnancy the vaccine will be offered. The Department of Health is awaiting guidance from the as to whether the vaccine can be given in the first as well as the second and third trimesters. More on this when I get it.

One final point: the seasonal flu immunisation campaign will continue as usual. The H1N1 swine flu jab will not protect you from seasonal flu, so it's important that if you need an annual flu jab, you turn up when contacted by your GP.

Intensive care: Another expert view

Fergus Walsh | 08:36 UK time, Friday, 18 September 2009

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Apologies to any of you who feel that, after a relative period of quiet, there's far too much speculation of the "what if?" variety here.

But having met so many interesting people in recent weeks, I thought it right to reflect some of their views here. So this is the final, Panorama-related item.

The posts this week are not intended - as one or two commentators suggested - to flam up swine flu. They are meant as added extras to the programme - a bit more detail which a blog can give.

Once again I return to the issue of intensive care. It seems clear that this will be the main pressure-point for the NHS in the next H1N1 swine flu peak. Plans were announced last week to double the number of intensive care beds.

So how feasible would it be to double the number if intensive care beds?

Professor Mervyn Singer discussed this with Mervyn Singer, Professor of Intensive Care Medicine at University College London. He said:

"We can double them, at least in the short-term, but there would be issues about the number and quality of the extra ventilators. Those used in operating theatres are not the same calibre and can't perform as well as an intensive care ventilator, which is much more sophisticated. It would also mean cancelling planned operations and other stresses on the system."

Professor Singer likened it to a response to wartime or a natural disaster - a short-term coping exercise which the NHS did well. But doubling the number of beds could not be continued indefinitely.

What sort of winter is he expecting?

"We are gearing up to be extremely busy. We normally run at 90% plus bed occupancy during the winter months and clearly if we have all these extra patients there will be major issues."

Professor Singer was one of a number of specialists who was doubtful about the use of ECMO in adult patients.

He felt that, although the technique of adding oxygen to the blood outside the body worked well in newborns, its benefits were not proven in adults.

Here is a brief section of my interview with Professor Singer.

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Expert view on virus mutation

Fergus Walsh | 10:50 UK time, Thursday, 17 September 2009

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I hope that last night's Panorama (which you can of course watch again) added to people's understanding of swine flu. I have no doubt that you will let me know what you think.

Dr Alan HayDr Alan Hay, director of the World Health Organization laboratory at Mill Hill in north London was one of the flu experts interviewed.

His is one of just four WHO influenza collaborating labs in the world and plays a key role in research.

He spoke about fears that the H1N1 virus might mutate and about antiviral resistance.

So far, there have just been isolated cases of Tamifllu resistance against H1N1 swine flu. Dr Hay said:

"The major problem in generating resistance is people start a course of Tamiflu and do not follow it rigorously during that period, such that the virus is exposed to a lower concentration of the drug that isn't as fully effective. That's when you get resistance emerging."

Like most experts he thinks there is a slim chance of H1N1 swine flu mixing with H5N1 bird flu to produce a more deadly strain of pandemic flu. A remote chance, but a chance nonetheless:

"There's a possibility that could happen, particularly in countries where human inflections of bird flu are continuing, for example Egypt. It's really the possibility that from that event might come a virus that might be similarly virulent to the bird flu virus but then has the capacity to establish and spread within the population. And that has been the fear of the last few years that has generated all this concerted action to prepare for a pandemic. And we are only now reaping the rewards of all that preparedness in the face of this pandemic."

You can see more of the interview with Dr Alan Hay done by my colleague Sophie Raworth:

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Treating the most seriously ill

Fergus Walsh | 08:49 UK time, Wednesday, 16 September 2009

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At every intensive care unit I visited in Sydney, one specialist treatment kept coming up which doctors in Australia are convinced has saved many lives.

ECMO, or to give its full title, extracorporeal membrane oxygenation, sounds complex, but does something that's easy to understand.

It takes over the work of the lungs, adding oxygen to the blood and removing carbon dioxide.

How EMCO works: 1) Blood is drained out of the body through a vein into the ECMO machine, which removes carbon dioxide and adds oxygen allowing the heart and lungs to rest  2) Blood is warmed before being returned to the heart - flow of blood out of the body is steadily reduced as patient recovers

Patients are attached to an ECMO machine when they are in severe respiratory failure - their lungs have failed. The blood is pumped outside the body, through the ECMO unit, and then back inside.

It differs from conventional ventilation which relies on some residual lung function.

ECMO has been around for many years, and is used in other areas such as cardiac surgery, to take over the function of the lungs during an operation.

It's also a proven treatment in neonatal units for newborns. But many doctors here remain sceptical about its use for adults with severe lung problems.

In Australia, intensive care specialists say they've found the technique of huge benefit in treating some of the sickest patients.

Dr Simon Finfer is originally from Britain, now working the Royal North Shore Hospital in Sydney:

"I think there are certainly patients who we are have treated with ECMO who are surviving who in our opinion would not have survived without this treatment."

Dr Finfer says that whereas most intensive care beds are occupied for just a few days, it was not unusual for patients with swine flu to be there for two weeks or more.

ECMO machineAt one stage, throughout Australia, 23 people, most of them adults, were on ECMO machines.

The UK, by contrast, currently has just five adult ECMO beds. These are all at one unit at Glenfield Hospital in Leicester.

In July, the issue of ECMO provision hit the headlines when a pregnant woman, Sharon Pentleton, was flown from Scotland to Sweden because the Leicester unit was full.

Sharon has since made a full recovery and it expecting her baby next month. In a Panorama special tonight at 9pm on 91Èȱ¬1 we interview Sharon about her experience:

"I went into hospital with a sore back and the next thing I knew I woke up in Sweden. It was really horrible especially waking up in a strange place and then I had all these tubes and couldn't breathe on my own. I was hooked up to all sorts of machines. It frightens me to realise how close I came to not being here at all."

The UK has a reciprocal agreement with other European countries about ECMO and admits more patients from Sweden than are sent there. But in a peak of swine flu it's likely that ECMO beds across Europe will be stretched.

So could the ECMO numbers be increased in the UK?

In fact there are 15 ECMO beds in total - 10 paediatric (at hospitals in Glasgow, Newcastle and London) and the five beds in Leicester, which are also used to treat children.

The team at Leicester says it could increase the number of ECMO beds to 10, because there are more machines available, but the technique is highly specialised and requires an extremely well-trained team.

It would require staff to be re-trained and elective surgery to be postponed - exactly what happened in Australia.

A long-running trial of ECMO has just been published by the Lancet involving nearly 200 patients.

It found that patients assigned to receive ECMO were more likely to survive than those who did not, the equivalent of one extra survivor for every six patients treated.

The ECMO group also included many who never actually received it but the researchers deny that this undermines the study.

The research pre-dates swine flu but one of the study authors, Giles Peek a cardiothoracic surgeon from Glenfield hospital says it's already helped to save lives:

"We have used ECMO during the first wave of the pandemic with good effect and we are expecting ECMO to prove an invaluable weapon against the winter resurgence of the infection."

Richard Firmin, another of the report authors and a cardiothoracic surgeon is director of the ECMO unit at Glenfield hospital:

"ECMO can support and allow patients with very severe lung disease to get better - even if they go through a phase where their lungs don't work at all. All other forms require of therapy require some lung function, so for the severest end of respiratory failure, I've no doubt that ECMO will play an increasing role."

In an accompanying comment, Dr Joseph Zwischenberger of the University of Kentucky praised the trial but said it would:

"[L]ikely provide ammunition for both those in favour and those against the use of ECMO in the adult population."

The Chief Medical Officer for England, Sir Liam Donaldson has pointed out that the paper was turned down by another journal a few months ago because of reservations about the study methods.

He also said opinion was divided in the medical community on expanding ECMO, so he'd asked a new expert group to look at the evidence.

So despite the Lancet paper, it remains a controversial technique. But what is clear is that specialists in Australia have found it invaluable in saving the lives of younger patients with swine flu.

Although the vast majority of people get a mild dose of swine flu, it has been one of the signatures of the H1N1 virus that it has caused severe viral pneumonia in a minority of cases, many of them young adults.

Dr Finfer, in Sydney, is well aware of the debate surrounding ECMO:

"Many would still consider it to be an experimental, unproven treatment. But I think the experience such as we're having now with much younger patients coming in with respiratory failure and people who are otherwise healthy beforehand and having them survive this treatment may well cause doctors around the world to revise their view of ECMO."

What the specialists in Sydney and Leicester have both noticed is that the H1N1 swine flu virus seems to be causing infection deeper in the lungs than other forms of flu.

They argue that this makes ECMO especially suitable because the viral pneumonia is so severe that the lungs cease to function.

Dr Eddie Stachowski, another intensive care specialist in Sydney at Westmead Hospital, agreed that ECMO had saved several lives this winter.

I asked him how the UK would cope if just five ECMO beds were available for adults and we had the same winter as Australia. He gave this stark warning:

"You're either going to have to ship them elsewhere for that level of support or if you can't ship them elsewhere they're probably going to die."

I spoke to Richard Firmin in the ECMO unit at Glenfield Hospital in Leicester.

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Another view from Australia

Fergus Walsh | 10:04 UK time, Tuesday, 15 September 2009

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If anyone wants to get an idea of what the next few months may be like in Britain, then Australia may give us some clues, having just come to the end of its first winter with swine flu (see yesterday's post).

I got an interesting perspective when I met , Professor of Virology at Westmead hospital in Sydney. Professor Dwyer divides his time between seeing patients, often in intensive care, and working in the virology lab.

I met him at the - Westmead has the main public health laboratory in New South Wales and works with the WHO on research and surveillance.

Westmead

In common with the other doctors I met in Australia, Professor Dwyer had never experienced a winter flu season like this one:

"It's been absolutely massive for us here, we've been working essentially twenty hours a day trying to churn through all the samples to work out what's swine flu. I see the patients as well, and I must say I've never seen so much influenza activity."

WestmeadProfessor Dwyer said that H1N1 swine flu was the dominant strain circulating, but that other seasonal strains were also around. He confirmed that the vast majority of people infected did not get very sick, and the majority of those who got complications had underlying health problems. But he said it was "unpredictable", in that a small minority of otherwise healthy individuals got very sick indeed.

"It's been absolutely striking how severe the infection has been in a small proportion of people. So in our intensive care unit here in western Sydney, we had about a third of the unit filled with people with swine flu, and they were often young, younger than you might expect.
Ìý
Normal influenza tends to to affect the elderly, but this is a disease that affects younger people mostly - so its been really very dramatic."

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You can see more on all of this is in Panorama tomorrow evening, and in the video above (which is not in the TV programme), Professor Dwyer shows me round his labs.

What can we learn from Australia?

Fergus Walsh | 11:50 UK time, Monday, 14 September 2009

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I want to begin with a confession. In recent weeks, my contribution to this blog has been somewhat patchy; for that, my apologies. It's felt a bit like when I look out of the window at my garden. I know there is work to be done, but it's finding the time - at least that's my excuse for an unkempt lawn.

walsh in australiaI've been working on an edition of Panorama about swine flu to be broadcast on Wednesday 16 September. Its rather ambitious title is: "Swine flu: Everything you need to know". I'll be interested to get your feedback. The other presenters are Sophie Raworth and Jeremy Vine.

For part of the film I went to Australia, which has been in the grip of the worst flu season for 40 years. It felt strange walking around Sydney with the temperature at 27C and knowing this was deep midwinter. No-one has quite been able to explain to me why flu should be so rampant in such hot temperatures. I'm told that in the tropics, where it's hot all year round, there is no flu season.

walsh in australiaHow has Australia fared? The H1N1 virus did not bring society to a halt, and there were no food or power shortages: so far, so good. But there was increased absenteeism from work. And the health service has been extremely busy with hospital intensive care units under immense pressure.

I visited several hospitals in Sydney which had all had to cancel planned surgery at the peak of the winter, in order to cope with the influx of patients with severe respiratory problems. Last week, UK health officials confirmed that they were prepared to take similar measures, if and when needed.

The video below shows an excerpt from the programme plus some extra interview material with from Westmead Children's Hospital in Sydney. He was incredibly helpful in suggesting where we filmed in Australia and has been quoted many times already in this blog.

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I got to meet some of his patients, including 18-month-old Emily, and her mother Louise. Emily has leukaemia and H1N1 swine flu. She was at increased risk of complications from the virus, but received prompt treatment with Tamiflu and is doing well.

You'll also hear from Professor Booy assessing the threat from swine flu and talking about the problems associated with obesity.

Intensive care, and more on vaccines

Fergus Walsh | 11:32 UK time, Friday, 11 September 2009

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Plans to double the amount of intensive care provision to deal with H1N1 swine flu cases have been outlined by health officials.

Hospital wardIt's an acceptance that hospital critical care is likely to come under intense pressure when the next wave of swine flu comes.

The plans for England were outlined by Ian Dalton, National Director of NHS Flu Resilience.

They would see a doubling of the current 1,982 adult intensive care beds. There are 363 paediatric critical care beds which would also be increased substantially. Similar arrangements will occur throughout the UK.

A doubling of intensive care beds is no easy task, because of the need for specialist ventilators and other equipment.

Equally important are the highly-trained members of staff who work in critical care. So how will it be done?

More ventilators are being bought. Staff who currently work in other areas are being trained in critical care. Recently retired hospital workers will be placed on a reserve list to be called up if necessary. Critical care teams may be asked to work longer hours.

All these measures will help, but there is one other dramatic measure required to increase intensive care provision - cancelling operations.

As and when a huge peak of swine flu cases occurs, the NHS is ready to postpone as much planned surgery as required in order to free up intensive care beds.

This will free ventilators currently used in theatre as well as critical care beds used for patients recovering from cardiac and other major surgery.

This would be a temporary measure which would last for weeks rather than months during the peak of any outbreak.

The plans are based on the assumption that 2% of swine flu cases require hospitalisation, but this has since been downgraded to 1%.

Meanwhile, cases of swine flu continue to decline. There were an estimated 3,000 new cases in England in the past week, down from 4,500 last week and the rate of GP consultations stands at just 8.6 per 100,000.

In Scotland, where the schools went back first, there has been a slight increase in GP consultations to 43.9 up from 40.2, so this might be a very early indication that cases are about to rise.

The United States has seen a sharp increase in swine flu in recent weeks.

The Chief Medical Officer, Sir Liam Donaldson, has spoken in upbeat terms about swine flu. He said "we are tantalisingly close to being able to win the battle against the virus".

He explained that the current dip in cases meant that there was a real chance that they could vaccinate at-risk groups before the outbreak took hold again.

And more pandemic H1N1 vaccine trials results have been published, this time from Australia []. The early results show that a single dose of the vaccine shows an immune response similar to that gained from seasonal flu jabs.

This is significant because it suggests that just one dose may be required to offer protection. All the worldwide planning to date on pandemic vaccines has worked on the assumption that injections would be required.

The study involving 240 healthy adults aged 18-64 also found that the vaccine has a similar side-effect profile to that of seasonal influenza vaccines. The vaccine was produced by CSL in Melbourne.

Dr Alan Hampson, Chair of the Australian Influenza Specialist Group said:

"The study showed that a very high percentage of the adult recipients produced a good antibody response, which should provide a high level of protection, to a single dose of vaccine made by conventional methods and formulated at the usual potency. This is great news as it means that available vaccine supplies will go much further than might have been anticipated and that protection can be achieved with a type of vaccine that has a long history of safe and effective use."

Professor Robert Booy, Head of Clinical Research at the National Centre for Immunisation Research & Surveillance (NCIRS) at the University of Sydney said:

"This is indeed very encouraging and perhaps as good as we could have hoped for in that it appears only one dose of vaccination is required. It is important too that the safety profile is good. Results in children are keenly awaited."

This follows similar results from an early trial using a pandemic vaccine made by Novartis. Results from trials involving the vaccines which will be used in the UK - being produced by GSK and Baxter - are yet to be published.

Swine flu deaths: Estimates scaled down

Fergus Walsh | 08:30 UK time, Friday, 4 September 2009

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You'll remember the headlines from last month suggesting that up to 65,000 people could die from H1N1 swine flu.

At the time I tried to put the figures in context and point out that this was not a true estimate of deaths but a worst-case planning scenario for the NHS which was extremely unlikely.

flu vaccineNow , based on new scientific advice. The 65,000 figure assumed a mortality of 0.35% or three and a half in every 1,000 people infected, and that 30% of the UK population would get infected.

The lower estimate of 0.1% mortality is now being used which gives a potential death toll of 19,000 if 30% were to get the virus.

But even this figure could be an over-estimate. So far, there have been 70 deaths linked to the virus in the UK but hundreds of thousands of people have already been infected.

So unless the virus changes its behaviour then the death toll will hopefully be much lower.

Swine flu vaccine

Meanwhile, . A study of 100 healthy adults in Leicester found that the vaccine produced a strong immune response with few apparent side effects apart from a sore arm.

The trial was carried out by the University of Leicester and Leicester Hospitals.

One of the scientists involved, Dr Iain Stephenson said:

"Results showed that the serum antibody responses were highest among subjects who received two doses of vaccine, however a single vaccine dose also induced responses associated with protection against influenza."

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