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Ian Dalton's swine flu update - protecting young children

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In his weekly update for HSJ and Nursing Times, national director for NHS flu resilience Ian Dalton discusses the latest developments in UK swine flu preparations

What should NHS staff be focusing their efforts on?

On Thursday 19 November we announced that we would be extending the swine flu vaccination programme beyond the initial priority groups. The first phase of delivery has been progressing well; anecdotal evidence suggests a good take-up of the vaccine among patients in the priority groups and eligible frontline staff, and we will share official uptake data as soon as this available.

Completing the vaccination of all of the initial priority groups – public and health and social care staff – remains our highest clinical priority, and it is important that we continue to work to achieve this. Once this is complete however, the joint committee on vaccination and immunisation supports our decision to offer the vaccine to all healthy children over six months and under five years of age.

Evidence shows that young children are currently suffering the greatest overall impact from the disease. Children under five are the age group with the consistently highest levels of hospital admissions.  By vaccinating as many children as possible, we will be offering them with the best possible protection against the virus.

We are currently working with the BMA and NHS organisations to agree exactly how this will take place, although we expect that, once negotiations are complete, GP practices will be able to begin vaccination of children over six months and under five as soon as they finish vaccinating their patients in the priority groups. 

The next steps

We have also taken note of the joint committee on vaccination and immunisation advice that the vaccination of main carers of older people and disabled people, whose welfare may be at risk if their carer falls ill, should be an important next group. Like frontline health and social care workers, carers have considerable ongoing responsibilities towards the health and welfare of others and are looking after vulnerable people who need to be protected from the risk of infection. We are therefore discussing how best to implement this advice with carers’ organisations to establish a sensible approach before communicating further detail on how the programme will work. 

In terms of any further extensions of the priority groups, the joint committee on vaccination and immunisation has advised that use of the vaccine in the wider healthy population should depend on the evolution of the pandemic as well as new and emerging clinical data on the use of the vaccine.

We are beginning to see the weekly numbers of cases decreasing slightly, with the estimated number of new cases at 53,000, which is down from 64,000 the previous week.

While it is too early to confirm that this will be an ongoing trend, it is positive news. However, alongside this reduction in the number of cases, there is still a relatively high proportion of patients in hospital and critical care, and we are still seeing a number of deaths from swine flu.

We are also beginning to see increased pressure within the system, particularly on A&E and ambulance services. We see additional pressure on NHS services each year, and we are well placed to manage them due to the plans we have in place, but it is a good reminder of the need to continue to remain prepared for what will potentially be a tough winter for the NHS.

Progress to date

We have also published the national summary report of “exercise peak practice”. This exercise was the whole system stress test that all 10 SHAs undertook as a key part of the board level assurance process that I asked all NHS trusts to complete by the end of September 2009. The report provides an overview of the 10 regional exercises and documents the high-level areas for further action identified by the delegates who attended. Nationally, exercise peak practice reaffirmed the extent and depth of planning that had already taken place in the NHS in readiness for a flu pandemic and demonstrated considerable leadership, commitment and planning undertaken by both clinical and managerial staff across the NHS.  This report is available on the Department of Health website, where the most up-to-date clinical information and guidance can also be found at

All the latest information on the current numbers of flu-like illnesses, GP consultation rates, hospitalisations and deaths can be found on the HPA website.

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