• Introduction
• Causes
• Symptoms
• Treatment
• Pregnant women
• Advice for carers
• Vaccine
• Selected links

Introduction

Swine flu is the common name given to a new strain of influenza (flu). It is called swine flu because it is thought to have originated in pigs, but this is not certain.

People with swine flu typically have a fever or high temperature (over 38°C) and may also have aching muscles, sore throat and/or a dry cough (see Symptoms). In other words, the symptoms are very similar to seasonal (regular) flu. Most people recover within a week, even without special treatment.

Pandemic

The virus was first identified in Mexico in April 2009. It has since become a pandemic, which means it has spread around the globe. It has spread quickly because it is a new type of flu virus that few, if any, people have full resistance to.

Flu pandemics are a natural event that occur from time to time. Last century, there were flu pandemics in 1918, 1957 and 1968, when millions of people died across the world.

In most cases the virus has proved relatively mild. However, around the world hundreds of people have died and it is not yet clear how big a risk the virus is. For this reason, and because all viruses can mutate to become more potent (stronger), scientists are saying we need to be careful.

The situation in the UK

The number of new swine flu cases has almost doubled in the past seven days, with an estimated 26,000 new cases this week. So far, 122 people have died in the UK.

The UK formally moved from a containment to a treatment phase for swine flu on July 2 2009. Intensive efforts to contain swine flu, for example through automatic school closures, ended. This was to free up capacity to treat the people who are contracting swine flu daily.

As in other countries, most of the cases reported so far in the UK have been mild. Only a small number have led to serious illness, and these have often been in patients with existing health problems, such as cancer, that already weakened their immune systems.

Some people believe that the government should only give antivirals to those who are most at risk of developing serious complications from swine flu. In other words, if people are otherwise healthy, the virus should be treated with with paracetamol and bed rest until the person is better, as you would with normal flu.

However, the government's Scientific Advisory Group on Emergencies (SAGE) believes that there is still some doubt about the risks of the virus. For example, there are reports of some cases in Argentina where young, healthy adults have become extremely ill from swine flu.

While there is still this doubt, the government has decided to offer the antiviral medicines Tamiflu or Relenza to everyone who is confirmed with swine flu.

High-risk groups

Some people are more at risk of complications if they catch swine flu, and need to start taking antivirals as soon as it is confirmed that they have the illness. Doctors may advise some high-risk patients to take antivirals before they have symptoms, if someone close to them has swine flu.

It is already known that people are particularly vulnerable if they have:

• chronic (long-term) lung disease,

• chronic heart disease,

• chronic kidney disease,

• chronic liver disease,

• chronic neurological disease (neurological disorders include motor neurone disease, multiple sclerosis and Parkinson's disease),

• immunosuppression (whether caused by disease or treatment), or

• diabetes mellitus.

Also at risk are:

• patients who have had drug treatment for asthma in the past three years,

• pregnant women,

• people aged 65 and over, and

• children under five.

Swine flu vaccine

The first swine-flu vaccinations have begun. The vaccine is being given to those at the greatest risk first. 

The vaccine will initially be given to the following groups, in this order:

• People aged between six months and 65 years who usually get the seasonal flu jab.

• Pregnant women, subject to licensing. The European Medicines Agency, who license the vaccine, will indicate whether it can be given to all pregnant women or whether it should only be offered at certain stages of pregnancy.

• People who live with those whose immune systems are compromised, such as cancer patients or people with HIV/AIDS.

• People aged 65 and over in the seasonal flu vaccine at-risk groups.

• Young children aged between six months and five years. 

• The Welsh Assembly Government has also decided that all children and young people with severe learning difficulties (SLD) will be treated as a priority for vaccination as they are at high risk of severe complications.

For more information, go to the Vaccination: Q&A.

To stop the virus spreading

Although the UK has moved to a treatment phase for swine flu, it is important that people continue to do everything they can to stop the virus from spreading.

The most important way is to have good respiratory and hand hygiene. In other words, always sneeze in to a tissue, and quickly put it in a bin. Wash your hands and home and work surfaces regularly and thoroughly to kill the virus.

Causes

Symptoms

If you are still concerned you may have swine flu, stay at home, contact your GP or NHS Direct Wales for further information.  

Call your GP directly if: 

• you have a serious existing illness that weakens your immune system, such as cancer,

• you are pregnant,

• you have a sick child under one,

• your condition suddenly gets much worse, or

• your condition is still getting worse after seven days (five for a child).

High-risk groups

For most people, swine flu is a mild illness. Some people get better by staying in bed, drinking plenty of water and taking over-the-counter flu medication.

However, some groups of people are more at risk of serious illness if they catch swine flu, and will need to start taking antiviral medication as it is confirmed that they have it.

It is already known that you are particularly at risk if you have:

• chronic (long-term) lung disease,

• chronic heart disease,

• chronic kidney disease,

• chronic liver disease,

• chronic neurological disease (neurological disorders include motor neurone disease, multiple sclerosis and Parkinson's disease),

• immunosuppression (whether caused by disease or treatment) or

• diabetes mellitus.

Also at risk are: 

• patients who have had drug treatment for asthma within the past three years,

• pregnant women,

• people aged 65 and older, and

• young children under five.

• The Welsh Assembly government has also decided that all children and young people with severe learning difficulties (SLD) will be treated as a priority for vaccination as they are at high risk of severe complications.

It is vital that people in these higher-risk groups who catch swine flu get antivirals and start taking them as soon as possible.

Outlook

For most people, the illness appears to be mild. Cases have been confirmed in all age groups, but children and younger people seem much more likely to be affected. To date, fewer cases have been confirmed in older adults.

For a minority of people, the virus has caused severe illness. In many of these cases, other factors have been identified that are likely to have contributed to the severity of the illness. 

Worldwide, just over 0.4% of the laboratory-confirmed cases reported to the World Health Organization (WHO) have died. This is a similar rate to ordinary flu. The true number of swine flu cases is likely to be significantly higher than that reported to WHO and therefore the figure of 0.4% is likely to be an overestimate of the death rate.

Where complications do occur, they tend to be caused by the virus affecting the lungs. Infections such as pneumonia can develop.

Treatment

The UK has large stocks of oseltamavir (Tamiflu) and zanamivir (Relenza) and there is currently enough to treat half the population should they become ill during the pandemic. Also, orders of Tamiflu have been placed to increase UK supplies to 50million doses, enough to treat 80% of the population.

Tamiflu and Relenza are both medicines of the same type, but Relenza comes as an inhaler (rather than a pill) and is recommended for use in pregnancy.

Currently, antiviral medication is being offered to people in Wales confirmed to have swine flu by their GP.

Antibiotics

Antibiotics are used to treat swine flu patients who develop complications. They help combat bacterial infections such as pneumonia.

The NHS already holds substantial stocks of antibiotics. Further orders have been placed for 15.2 million courses of antibiotics to help fight swine flu.

In hospitals, antibiotics will be used to treat the most ill patients and may reduce the length of hospitalisation.

Vaccine

 Priority Groups

Priority groups for immunisation, as recommended by independent experts will be offered the vaccine initially. They are:

People aged between six months and 65 years who are already in the current seasonal flu vaccine clinical at-risk groups (see below),

• All pregnant women,

• People who live with those whose immune systems are compromised, such as cancer patients or people with HIV/AIDS.

• People aged 65 and over in the current seasonal flu vaccine clinical at-risk groups (see below).

• The Welsh Assembly Government has also decided that all children and young people with severe learning difficulties (SLD) will be treated as a priority for vaccination as they are at high risk of severe complications.

It is especially important that at-risk groups get antivirals and start taking them as soon after symptoms start as possible. At-risk groups include people with:

•  chronic (long-term) lung disease,

• chronic heart disease,

• chronic kidney disease,

• chronic liver disease,

• chronic neurological disease (neurological disorders include, motor neurone disease, Parkinson's disease and multiple sclerosis),

• immunosuppression (whether caused by disease or treatment), or 

• diabetes mellitus.

Also at risk are: 

• patients who have had drug treatment for asthma within the past three years,

• pregnant women,

• people aged 65 and over, and

• young children under five.

Pregnant women

If you are pregnant, you are in one of the high-risk groups for swine flu, so it is important to read this page carefully and follow the advice to protect yourself and your baby.

This page explains why pregnant women are at greater risk from swine flu, what those risks are, the special precautions you should take and the safety information for swine flu treatments.

Why pregnant women are more at risk

In pregnancy, the immune system is naturally suppressed. This means that pregnant women are more likely to catch swine flu, and if they do catch it, they are more likely to develop complications (see below).

Don't panic: your immune system still functions and the risk of complications is very small. Most pregnant women will only have mild symptoms.

Symptoms and risks

If you are pregnant and you catch swine flu, the symptoms should be similar to those of regular flu. You will typically have a fever or high temperature (over 38°C/100.4°F) and two or more of the following:

• unusual tiredness,

• headache,

• runny nose,

• sore throat,

• shortness of breath or cough,

• loss of appetite,

• aching muscles, 

• diarrhoea or vomiting.

   

Most pregnant women will have only mild symptoms and recover within a week. However, there is evidence from previous flu pandemics that pregnant women are more likely to develop complications.

Possible complications are:

• pneumonia (an infection of the lungs),

• difficulty breathing, and 

• dehydration.

In pregnant women, these are more likely to happen in the second and third trimester.

If a pregnant woman develops a complication of swine flu, such as pneumonia, there is a small chance this will lead to premature labour or miscarriage. There is not yet enough information to know precisely how likely these birth risks are.

It is therefore important to be well prepared and to take precautions against swine flu.

Special precautions

If you are pregnant, you can reduce your risk of infection by avoiding unnecessary travel and avoiding crowds where possible.

Pregnant women should also follow the general advice for reducing the risk of catching swine flu.

If a family member or other close contact has swine flu, your doctor may prescribe you antiviral medication (usually Relenza) as a prophylactic (preventative) measure.

If you think that you may have swine flu, call your doctor for an assessment immediately. If your doctor confirms swine flu over the phone, you will be prescribed antiviral medication to take as soon as possible (see box, left).

Unless you have swine flu symptoms, carry on attending your antenatal appointments to monitor the progress of your pregnancy.

Swine flu treatment

Antivirals

If you are pregnant and diagnosed with swine flu, you will usually be given a course of the antiviral drug Relenza, which is inhaled using a disk-shaped inhaler. It is recommended for pregnant women because it easily reaches the throat and lungs, where it is needed, and does not reach significant levels in the blood or placenta. Relenza should not affect your pregnancy or your growing baby.

However, if your doctor or midwife thinks that a different medicine is needed (for instance, if you have unusually severe flu), you will be given Tamiflu instead.

An expert group reviewed the risk of antiviral treatment in pregnancy. It is much smaller than the risk posed by the symptoms of swine flu.

Some people have had wheezing or serious breathing problems when they have used Relenza. Relenza is therefore not recommended for people with asthma or chronic obstructive pulmonary disease (COPD). Other possible side effects include headaches, diarrhoea, nausea and vomiting.

In a small number of cases, nausea is a side effect of Tamiflu.

If you take an antiviral and have side effects, see your healthcare professional to check that you are OK. Then report your suspected drug reaction to the Medicines and Healthcare products Regulatory Agency (MHRA) using their new online system.

Painkillers

You can also take paracetamol to reduce fever and other symptoms; this is safe to take in pregnancy.

However, pregnant women should not take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Nurofen).

Vaccine

A swine flu vaccination programme is now underway in Wales.  Pregnant women are one of the priority groups for the vaccine (see Who will be priority for vaccination with the swine flu vaccine?) and should take this as soon as it is offered. 

The European Medicines Agency has said Pandemrix and Celvapan can be given to pregnant women. Pregnant women are recommended to have the swine flu vaccine because they are at greater risk of being seriously ill with swine flu. They also have a higher risk of needing to go to hospital if they catch swine flu. 

These risks increase during the later stages of pregnancy. If you are about to give birth and there are a lot of cases of swine flu locally, having the swine flu vaccine could help you avoid catching swine flu and then passing it to your baby.

The Pandemrix vaccine can be given in one dose rather than two spread over three weeks and therefore be more attractive to women in the later stage of pregnancy. The vaccine will not harm you or your unborn baby.

Advice for carers

Swine flu advice for carers 

Now there is a flu pandemic, you or the person you care for may get flu. 

You may be managing to care for someone on your own, but if their needs increase because of flu, or if you get flu yourself, you may not be able to cope. People with underlying health conditions and older people are generally more likely to develop complications from flu, although it is not yet clear whether the same groups would be vulnerable to swine flu or another type of pandemic flu.   

If you employ someone else to help you with your caring tasks, or so you can have a break, that person may also be affected by flu. 

Other relatives or friends may also get flu, and may not be able to help you. You may even feel you need look after them while they are ill.

It is very important that you prepare in advance for these possibilities. 

If you provide a regular and substantial amount of care or support for someone, talk to your local authority about having a carer’s assessment. This will identify your needs as a carer and is an opportunity to talk about planning for emergency situations.

If you or the person you care for have already had an assessment and are eligible for local authority support, you may have chosen to receive a Direct Payment or Individual Budget to buy the services you need yourself. It is important that your care plan includes arrangements for emergency care.

Your local authority may be able to provide emergency respite care for the person you look after until you are well again, but you should discuss with them how and when this would happen.  During a flu pandemic, emergency respite care will probably be more difficult to organise.

A flu pandemic means that hospitals have to deal with more patients than usual, so people who under normal circumstances would be cared for in hospital will have to be looked after at home.

As part of your preparations think about:

• what if you get flu?

• what if the person you care for gets flu?

• what if your regular home help, nurse or other carer cannot come to work?

• what if a day centre closes?

Ask your local authority if there are any aids or equipment they can provide or that you can buy to help you manage more easily with your caring role. 

Vaccine

The swine flu vaccination programme has been underway in Wales since the end of October 2009, with the highest-risk groups being offered the vaccine first.

The vaccine is being given to seriously ill hospital patients and healthcare staff. Other at-risk groups, such as pregnant women and those with weakened immune systems, are next to have the vaccine.

If you have any questions about the swine flu vaccine or about receiving the vaccination, please read this page carefully.

This page explains who will get the swine flu vaccine and why, the vaccination programme, effectiveness of the vaccine, and safety issues.

Who will get the vaccine?

The groups of people who are most vulnerable to serious illness from swine flu will be offered the vaccine first. In order of priority, these are:

• People aged between six months and 65 years in the seasonal flu vaccine at-risk groups (listed below).

• Pregnant women.

• People who live with someone whose immune system is compromised (for example, people with cancer or HIV/AIDS).

• People aged 65 and over in the seasonal flu vaccine at-risk groups

• Young children aged between six months and five years.

• The Welsh Assembly government has also decided that all children and young people with severe learning difficulties (SLD) will be treated as a priority for vaccination as they are at high risk of severe complications.

Frontline health and social care workers will also be offered the vaccine at the same time as the first clinical at-risk groups. Health and social care workers both have an increased risk of catching swine flu and of spreading it to other at-risk patients.

The seasonal flu vaccine at-risk groups are people with:

• Chronic lung disease, such as chronic obstructive pulmonary disease (COPD), chronic bronchitis and cystic fibrosis. Also included are people with severe asthma who need to continuously or repeatedly use their inhaler or take steroid medication, or who have been admitted to hospital because of their asthma.

• Chronic heart disease, including heart failure, congenital heart disease, and heart disease caused by high blood pressure.

• Chronic kidney disease, such as kidney failure and people who have had a kidney transplant.

• Chronic liver disease, such as cirrhosis and chronic hepatitis.

• Chronic neurological disease, such as stroke, Parkinson's disease, cerebral palsy, motor neurone disease or multiple sclerosis.

• Diabetes.

• Immunosuppression (a suppressed immune system), due to disease or treatment. This includes people who have a damaged or no spleen, people having chemotherapy or other immunosuppressant treatment, and those on high doses of steroid medication.

Healthy people aged over 65 are not a swine flu priority group as they appear to have some natural immunity to the swine flu virus. Surveillance has shown fewer swine flu cases in people over 65 than in younger people.

While children are disproportionately affected by swine flu, the majority make a full recovery. Therefore the experts do not advise that children (other than those in at-risk groups) should be vaccinated initially.

Babies under six months cannot be vaccinated because the flu vaccines do not produce enough of an immune response in them to provide protection.

Pregnant women, however, are a priority group as they are more vulnerable to complications following swine flu infection (see Advice for pregnant women).

What about the rest of the population?

The Joint Committee on Vaccination and Immunisation (JCVI) has advised that the use of the vaccine in the wider healthy population should depend on how the pandemic evolves and on emerging clinical data on the use of the vaccine.

After careful consideration, the Welsh Assembly Government has decided to focus on young children (aged six months to five years) next, and also look at the possibility of offering the vaccine to carers.

Evidence shows that young children are currently suffering the greatest relative impact from the disease. For example, children under five have the highest rate of hospitalisation for swine flu.Vaccination will mean that fewer children in this age group will become seriously ill and need hospital treatment.

The second phase of the vaccination programme in Wales is currently underway.

Enough vaccine has been ordered for the whole population, and its use will be kept under review.

The vaccination programme.

The vaccination programme began in Wales in October 2009, with high-priority groups getting the vaccine first.

Vaccination is not compulsory. As with any vaccination, everyone has a right to refuse it.

The swine flu vaccine can be given at the same time as other vaccines, including the seasonal flu jab. If you are normally advised to have the seasonal flu vaccine each winter, you need to continue to receive this every year to ensure that you are protected against most of the flu strains in circulation.
 
Dosage

The following vaccination schedule is recommended in the UK:

Pandemrix:

• For children aged from six months and under 10 years:
one half dose (0.25ml) unless the child is immunocompromised or has an immune deficiency.

• For individuals aged 10-59:
- one dose (0.5ml) given.

• For individuals aged 60 years and over:
- one dose given (this advice will be reviewed when more data become available).
 
• For individuals aged 10 years and over with weakened immune systems:
- two doses (0.5ml each) given with a minimum of three weeks between doses.


Celvapan:
 
• For children aged from six months and adults:
- two doses (0.5ml each) given with a minimum of three weeks between doses.

This dosage schedule is based on advice given by the Joint Committee on Vaccination and Immunisation, following consideration of clinical data available on the vaccines. The dosage and recommendations will be kept under review as more clinical data become available.

Effectiveness of the vaccine

Seasonal flu vaccines give around 70-80% protection against infection with flu virus strains. Because the swine flu vaccines are an exact match to the swine flu strain that is currently circulating, they should give at least this amount of protection.

The government will be able to to measure the effectiveness of the swine flu vaccines once they are in use against swine flu.

The swine flu prototype vaccines have been clinically tested and shown to produce good immune system responses, and have an acceptable safety profile. The insertion of the H1N1 strain into the vaccine should not substantially affect the safety of the vaccine in the same way that annual modifications to the seasonal flu vaccine do not.

The swine flu vaccine should provide protection against the pandemic strain of swine flu for several years following vaccination. As well as offering protection against the serious effects of swine flu, it may also help to reduce the spread of the infection.

Safety issues

The government takes decisions about introducing a new vaccine very seriously. Vaccines would not be licensed if they were considered unsafe.

Similar flu vaccines containing a different flu virus strain (H5N1) have been clinically tested and the trials showed that these vaccines are safe and produce enough antibodies to provide protection.

Experience with seasonal flu vaccines has shown that changing the strain of virus in a vaccine does not substantially affect the safety profile of the vaccines.

But, as with any new vaccine, some very rare side effects cannot be identified or excluded until the swine flu vaccines are used in much larger numbers of people in the general population.

Outcomes of trials to date suggest that pandemic vaccines are as safe as seasonal flu vaccines.

Pregnant women

There is no evidence that inactivated vaccines, such as the swine flu vaccine, will cause any harm to pregnant women or their unborn baby. Every year, the seasonal flu vaccine is given to pregnant women who are at risk of seasonal flu.

The Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency has given a clear recommendation that the GlaxoSmithKline vaccine Pandemrix can be given safely to pregnant women.

For more information on the vaccine please visit our swine flu Q&A page.
 

Selected links

• Health Protection Agency
• World Health Organization
• Foreign & Commonwealth Office