Swine flu updates
LATEST 29 Sep 2011: Click here to view patient information produced by the NHS on seasonal flu and pregnancy.
4 April: The National Institute for Health Research (NIHR) has issued a call for research on pandemic influenza. For more information, click here. Please submit all completed expressions of interest to: firstname.lastname@example.org by 1.00pm on Thursday 5 May 2011.
1 Feb 2011: The Department of Health and Health Protection Agency have issued updated advice for maternity services. To view, click here.
Please note that the National Pandemic Flu Service will no longer operate from 01.00 on 11 February 2010. Anyone who suspects they have H1N1v flu should see their GP. If needed, their GP will prescribe antiviral treatment.
Documents produced by the Pandemic Flu Planning Group
5 Nov 2010: The DH has issued a further update on guidance. To view this document, please click here.
15 Oct: The DH, alongside stakeholders including RCOG, RCM and RCGP, have produced updated guidance for healthcare professionals on the seasonal influenza vaccination programme. To view this document, please click here. NOTE: This document has since been updated, please refer to the posting above on 5 Nov 10.
- 12 May: Click here for new information for pregnant women on the H1N1v flu, obtaining vaccines and overseas travel advice.
- 15 Dec 2009: The pregnancy clinical management guidelines have been updated. To access the revised document, click here. There are two changes: See footnote in para 5, p. 17 on the different requirements of the abortion legislation in England and Northern Ireland. See new para 5, p. 19 for reference to the ORACLE study which implicated co-amoxiclav with necrotising enterocolitis in preterm prelabour rupture of membranes.
- 10 Dec: Click here for the RCOG webcasts on swine flu in pregnancy. These presentations were featured at the Public Symposium which took place at the RCOG on 12 Oct 2009.
- 30 Oct: Click here for clinical management guidelines produced by the RCOG and DH. (pdf) NOTE: This document has since been updated, please refer to the posting above on 15 Dec 09.
- 24 Aug: Click here for an update on clinical advice for doctors in cases of severe complication and signs of hypoxia in pregnant women. (pdf)
- 29 July: Click here for Q&A: Managing pregnant women with suspected swine flu - advice for healthcare professionals. (pdf)
- 9 July: Click here for the algorithm on the management of H1N1 in pregnancy and infection control guidance. (pdf)
- 8 July: Click here for advice to pregnant women on the swine flu pandemic this autumn/winter. (pdf)
Useful resources from the Department of Health
20 Dec 2010: The Department of Health has released an update on the use of ECMO to treat pregnant women with H1N1v flu. To view, click here.
17 Dec: The Department of Health has released new advice on H1N1v flu for maternity services. To view, click here.
16 Dec: Following from the letter posted on 14 Dec below, the Department of Health would like to remind RCOG members about encouraging pregnant women to have the influenza vaccination. A useful Q&A is included in the annex. To view the document, please click here.
- 30 Sep: This year's NHS seasonal influenza vaccination programme includes ALL pregnant women. To view the DH press release, click here.
- 28 May: The Department of Health has issued guidance on the annual seasonal influenza immunisation programme for winter 2010/11, including influenza immunisation for pregnant women and frontline health and social care staff. To view the letter, click here.
- 4 Feb: The Department of Health has announced the National Pandemic Flu Service will stand down on 11 Feb. Click here to view the Ministerial statement.
- 19 Nov 2009: The Department of Health has issued a letter to all trusts on the second phase of the H1N1v flu vaccination programme. It includes a section on pregnancy. To view, click here.
- 11 Nov: Click here for NHS patient information leaflet on swine flu and pregnancy How to protect yourself and your baby.
- 11 Nov: The Department of Health has issued new national guidance on the role and contribution of medical students and trainees in the H1N1v flu pandemic. Similar advice is available for other healthcare students.
- 2 Nov: The Department of Health has issued a letter to all GPs and nurses on the H1N1v flu vaccination programme for pregnant women. Included is a useful Q&A document at the end. To view, click here.
- 28 Oct: The Department of Health has produced a briefing document on the H1N1v flu vaccines for clinicians. To view, click here. New guidance for pregnant healthcare professionals on protecting themselves from H1N1v flu infection in the workplace have also been issued. To view, click here.
- 22 Oct: The Department of Health have updated the Green Book with a new chapter on H1N1v flu. To view Chapter 23a Pandemic influenza A(H1N1)v 2009 (swine flu), click here. A new swine flu vaccination leaflet has also been produced. To view, click here.
- 19 Oct: The Department of Health has produced a Q&A document on the H1N1v flu vaccines. To view, click here.
- 15 Oct: The Department of Health has published guidance on antiviral prophylaxis during the H1N1v flu pandemic. To view, click here.
- 29 Sep: The Department of Health has updated their guidance on the use of antivirals for pregnant women, those who are breastfeeding and children under one. To view the latest advice, please click here .
Useful resources from other organisations
10 Jan 2011: The Centre for Maternal and Child Enquries (CMACE) has published its review of maternal deaths in the UK from H1N1v flu. To view, click here.
24 Dec 10: The Centre for Maternal and Child Enquries (CMACE) has produced a briefing for healthcare professionals on maternal mortality due to H1N1v flu. To view, click here.
14 Dec 10: The HPA have noticed an increase in cases of those with H1N1v flu requiring critical care. In response, the CMO published this letter to healthcare professionals in secondary care, including advice for those caring for pregnant women.
13 Aug: The WHO have reported outbreaks of seasonal flu in India and New Zealand. The viral strain is H1N1v flu. To view the latest report, please click here. UK citizens, especially pregnant women, travelling to the Indian sub-continent and Australasia are advised to speak to their GPs about getting the flu vaccination.
11 Aug: Advice from the HPA on the post-pandemic phase can be found here.
10 Aug: The WHO have announced that the world is no longer at phase 6 of the H1N1v flu pandemic alert. To read more click here. Continued surveillance and vigilance are necessary in the immediate post-pandemic period to ensure flu preparedness.
For patients: Previous advice on hygiene remains. Pregnant women in risk groups should be offered the trivalent seasonal flu vaccine, as usual. This year's vaccine contains a component effective in immunising against H1N1v flu. Pregnant women NOT in risk groups, and who have not previously had the H1N1 pandemic vaccine should be offered immunisation with a single dose of the trivalent seasonal flu vaccine. This advice will be reviewed after the 2010-2011 season.
For doctors: Patients with severe or deteriorating influenza should be treated immediately with oseltamivir. Patients who are at higher risk of severe or complicated influenza should be treated with oseltamivir or zanamivir as soon as possible.
- 10 Feb 10: BJOG has published a study from Singapore on H1N1v flu in pregnancy. To view the press release, click here.
- 7 Jan 2010: Click here to view UKOSS's H1N1 in Pregnancy Interim Report No.3: Women admitted to hospital with laboratory confirmed H1N1v infection.
- 18 Dec 09: The Health Protection Agency (HPA) has produced two new documents: click here for inpatient clinical management of oseltamivir-resistant pandemic H1N1v flu and here for antiviral susceptibility testing of the H1N1v flu.
- 4 Dec: The Health Protection Agency (HPA) has produced several documents on H1N1v flu and pregnancy. Click here for the Q&A on the swine flu vaccines for pregnant women. Click here for their advice on swine flu and pregnancy.
- 3 Dec: The EMEA will publish weekly pandemic pharmocovigilance reports on its frontpage. The first report can be found here.
- 1 Dec: Click here to view UKOSS's H1N1 in Pregnancy Interim Report No.2: Women admitted to hospital with laboratory confirmed H1N1v infection.
- 27 Nov: Joint RCGP / RCM / RCOG letter to nurses and midwives on the importance of vaccinating pregnant women against swine flu. To view, click here.
- 23 Nov: The Royal College of Paediatrics and Child Health (RCPCH) and RCOG have released a Q&A document for parents of newborns on swine flu. To view, click here.
- 20 Nov: Click here for the UKOSS H1N1 in Pregnancy Interim Report no. 1. (pdf)
- 14 Oct: The MHRA have issued a letter warning against dissolving Relenza inhalation powder for administration via a nebuliser. To view this alert, please click here.
- 12 Oct: Further to the announcement on 25 Sep, the EMEA have approved the use of the vaccine Celvapan for the H1N1v flu. To view the press release, please click here.
- 25 Sep: The European Medicines Agency (EMEA) has approved the use of two H1N1v flu vaccines: Focetria and Pandemrix. To view their Q&A document, please click here. To view their press release, please click here. At the moment, the Committee for Medicinal Products for Human Use (CHMP) of the EMEA recommends two doses of the vaccine, at an interval of three weeks, are provided to establish immunity. Should clinical trials show that a single dose is effective, then, the advice will change. The vaccination programme is expected to commence in October. Guidance on the use of the vaccines in pregnancy will be available soon once the licensing arrangements have been confirme
- 18 Aug: Click here for advice by the UK National Screening Committee for SHAs and PCTs on the planning of antenatal screening services during pandemic influenza.
- 6 August: Click here for advice from the Medical Schools Council on the use of medical students to support the NHS in an influenza pandemic. The GMC's document on the responsibilities of doctors during a pandemic can be found here.
- 23 July: Click here for 'Swine flu: Advice for pregnant women', NHS Choices.
- 20 July: Click here for the Chief Medical Officer's advice to pregnant women.
- Click here for information for GPs produced by the RCGP.
- 26 Oct 2009: RCOG Statement on H1N1v flu vaccination programme for healthcare professionals and pregnant women. To view, click here.
- 29 July: To view the RCOG statement on the CDC paper on H1N1 flu and pregnancy published in The Lancet, please click here.
- 17 July: Click here for the RCOG/RCM statement – Advice on swine flu and pregnancy.
- 7 May: Click here to view the RCOG's statement on swine flu.
Archive (please refer to documents above for more updated information)
UKOSS and the UK Teratology Information Service were funded to carry out a rapid study of H1N1v flu in pregnancy in the UK to produce guidance to improve outcomes for women and infants. Clinicians were requested to report any pregnant woman admitted to hospital with H1N1v to UKOSS. Pregnant women with confirmed or suspected H1N1v infection in the community but who are not admitted to hospital were reported to the UK Teratology Information Service. NOTE: The deadline for reporting these cases was 31 January 2010.
(7 Oct 2009)
EBSCO Publishing has made their resources for health professionals on H1N1v flu free in light of the pandemic. To view, please click here.
The Department of Health has announced that pregnant women are a priority group to receive the H1N1v flu vaccine, according to the terms of the licence. Currently, clinical trials are taking place and the results are due soon. The European Medicines Agency (EMEA) will decide on the suitability of vaccines and is expected to grant the licences in October. After this, a national vaccination programme will commence. Only those who are on the priority list will be given the vaccines. For more information, please click here.
Flu service hotline
The number for the National Pandemic Flu Service is 0800 1513 100 or log on www.direct.gov.uk/pandemicflu. Current operating hours are 8.00am – 12.00pm. Pregnant women, women with serious underlying health conditions and infants below the age of one are advised to contact their GP.
This service is only available in England. The separate numbers operate in each of the other nations. These are:
- Scotland 08454 24 24 24
- Wales 0845 46 47
- Northern Ireland 0800 0514 142
For more information on the hotline, please visit the Department of Health.
The World Health Organization (WHO) has declared Phase 6 of its pandemic alert system, which means that swine flu is now spreading in communities in several countries. Current guidance in the UK for pregnant and breastfeeding women remains unchanged. The advice is that pregnant women should consult their GP or midwife if they have any symptoms of the flu. Relenza should be prescribed as the first-line treatment unless women have a contraindication to it, are unable to use an inhaler, or if a systemic preparation is needed. Tamiflu should be given if this is the case. Symptoms generally remain mild but it is important to monitor and share information should any colleague know of a pregnant woman who is affected.
The Department of health has issued guidance on Pregnancy, Breastfeeding and Swine Flu. NOTE: This document has since been updated, please refer to the posting above on 29 Sep 09.
As the current disease pattern in Europe and the UK shows that it tends to be a mild respiratory disease, the advice for pregnant women is that they should be administered with Relenza and not Tamiflu if they require antivirals. Should the disease show a more aggressive, systemic pattern, this advice may change. The Department of Health recommends Relenza as the preferred medicine at this moment as it reaches only very low levels in the blood and tissues, and would therefore limit the potential for placental and fetal exposure.
The Lancet and Elsvier have launched a H1N1 Flu Resource Centre for healthcare professionals. For more information, see http://www.thelancet.com/H1N1-flu.
• Recorded updates are available via the number 0800 1513513. A symptom checker is available on the NHS Choices website http://www.nhs.uk/Pages/HomePage.aspx
• Currently, only suspected patients displaying symptoms will be treated with antivirals when they see an NHS doctor.
• Pregnant women who have no symptoms should not be self-medicating with Relenza as this is a prescription drug.