Website of the Department of Health

Question

02. What is the difference between seasonal, avian and pandemic flu?

Answer

It is important to be clear about the differences between seasonal flu, avian flu and pandemic flu. Avian flu is a disease which mainly affects birds. Seasonal flu refers to the viruses that circulate in the human population and cause widespread illness each winter. Pandemic flu occurs infrequently, when a new influenza virus emerges which is markedly different from those recently circulating in the human population, causes disease in people and spreads easily between people because they have little or no immunity to it. This could happen through an avian flu virus (such as H5N1) mutating into a different strain with greater affinity for people.

Question

03. Are we at risk right now?

Answer

A pandemic can start when three conditions have been met:
1. a new influenza virus subtype emerges;
2. it infects humans, causing serious illness; and
3. it spreads easily and sustainably among humans.  
The H5N1 virus meets the first two conditions and it is likely that nobody will have immunity should an H5N1-like pandemic virus emerge. The H5N1 virus has not yet demonstrated the ability to pass easily between people. However, the virus is currently passing from birds to humans so it could develop the ability to pass easily between people. These opportunities will also persist as long as the virus continues to circulate in birds.

Question

04. Is another influenza pandemic likely?

Answer

Flu viruses are constantly changing and adapting, so it is likely that viruses sufficiently different from ‘ordinary’ flu strains to cause a pandemic will emerge from time to time. Experts are particularly concerned that the H5N1 virus, which has already caused disease and death in humans, may develop the capacity to pass easily between people.

Question

05. What alert level are we at now?

Answer

The World Health Organization (WHO) has developed an alert system to help inform the world about the current threat of a pandemic emerging. The alert system has six phases, with Phase 1 having the lowest risk of human cases and Phase 6 posing the greatest risk of pandemic. The world is presently in Phase 3 of the Pandemic Alert. This means that there is a new influenza virus subtype causing disease in humans, but it is not yet spreading in an efficient (easily transmittable) and sustainable manner among humans.

Question

06. Where is the new virus likely to come from?

Answer

Past experience suggests that it will first appear in South East Asia, the Middle East or Africa but it could be anywhere including the UK.

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07. How is the virus spread?

Answer

The virus is passed from person to person by breathing in air containing the virus produced when an infected person talks, coughs or sneezes. It can also be spread through hand/face contact after touching a person or surface contaminated with the virus.

Question

08. Can it be prevented at any stage?

Answer

International effort will attempt to try to control a pandemic when it emerges. The World Health Organization has stockpiled supplies of antivirals which will be targeted to the infected area in order to try to slow or stop the spread.

Question

09. What are the symptoms of pandemic flu?

Answer

People infected with the current strand of the avian virus (H5N1) have shown everything from typical human influenza-like symptoms (fever, cough, sore throat, and muscle aches) to pneumonia, severe respiratory diseases, and other life-threatening complications. Symptoms of avian influenza may depend on which specific virus subtype and strain caused the infection.

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10. How are people treated?

Answer

Medicines called antivirals can be used to treat influenza. They have been shown to be very helpful in the treatment of 'ordinary' seasonal flu, and it is likely that they will also be effective in the treatment of pandemic flu, but their effectiveness will not be known until the pandemic virus is circulating. Antivirals do not stop the flu from developing but they do subdue the symptoms and reduce the length of time people are sick.

The National Framework

Question

11. What contingency plan does the UK have for pandemic flu?

Answer

The National Framework is one of the first pandemic flu frameworks for cross government joint planning published by any European country. It recognises that a pandemic would have significant social and economic impacts as well as its serious effect on the health of the population. Joint and integrated plans are therefore critical to mitigating its overall effect and this joint guidance is a further major step in developing, improving and maintaining UK preparedness.   

Whilst much of the guidance material it contains was already available from various published sources, the Framework brings that together for the first time to provide a national blueprint for the UK’s response and to assist planners by providing standard assumptions and presumptions that can be used across all sectors.

Question

12. What would we do if pandemic flu arrives?

Answer

If a pandemic started outside the UK, the Government would already have put its contingency plan into action and started preparing for the pandemic in the UK. A graduated series of public health measures would be implemented to reduce the impact, and help control the pandemic.

Question

13. What preparations are being made in the UK?

Answer

We are taking the necessary steps to prepare for a future pandemic and are working to ensure our response is proportionate to the risk posed.

Publishing the National Framework was an important step. But improving our preparedness is ongoing work, putting into place the actions described in the framework.

We have provided guidance to the NHS and we have been commended by the World Health Organisation for being one of the best prepared countries in the world. The WHO report was also useful in highlighting areas in which we could improve.

We have made several direct interventions including the procurement of enough antivirals to treat twenty five percent of the population. We are planning to double this stock of antivirals, to cover at least half the population (the reasonable ‘worst case scenario’ of how many people could be expected to require treatment) and we will continue to keep the level of stock under review in light of the scientific evidence, as we develop our business case. We have also purchased 3.3 million doses of H5N1 vaccine for research and the possible vaccination of healthcare workers. We have an agreed advance supply contract for the supply of a pandemic specific vaccine in the event of a pandemic. Our countermeasures and vaccination strategy is under regular review.

Impact

Question

14. How many people in the UK will become ill?

Answer

We have carried out detailed modelling up to a reasonable worst case where 50 percent of the population will become ill with pandemic flu (the clinical attack rate). The national framework considers the range from 25 to 50 percent in clinical attack rate as well as ranges of 0.4 to 2.5 percent for case fatality.

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15. How many people will die in the UK?

Answer

This will depend upon the detailed properties of the pandemic virus. The range of scenarios outlined above give mortality estimates of between 50,000 and 750,000 additional deaths, depending on both the attack rate and case fatality rate.

Question

16. How will a pandemic impact upon businesses?

Answer

An influenza pandemic is likely to cause wide ranging disruption to most aspects of normal life. We are working across government to engage essential services and encourage them to develop robust business continuity plans appropriate for a flu pandemic. We are also working with representatives of business such as CBI and British Chambers of Commerce through the Cabinet Office Business Forum to ensure they have the information they need to plan for the impact of a pandemic on their business. Further information relating to business continuity planning can be found in annex J of the UK Influenza Pandemic Contingency Plan which is available on this website. Additional guidance on planning for pandemic flu was published in February 2006 by the Cabinet Office. This can be found at www.ukresilience.info, which also provides general information regarding contingency planning for businesses and other organisations. A checklist for business continuity planning can also be found on this website.

Question

17. Will other sectors of the community be affected?

Answer

Pandemic flu will impact on all services including health, police, fire, the military, fuel supply, food supply, food preparation, distribution and transport, prisons, education and business. All are likely to be affected by staff sickness, travel restrictions and other potentially restrictive countermeasures, and the knock-on effects of reduced transport, deliveries etc. We are working to ensure all sectors have plans in place for mitigating these impacts as far as is possible.

Question

18. Will people be prevented from travelling?

Answer

The Government is not planning to restrict travel within the UK during a pandemic unless it becomes necessary for public health reasons. Any restrictions which are considered are likely to be on an advisory basis. Scientific modelling shows that internal travel restrictions would have little impact on the total number of people infected by flu. The public will be advised to reduce non-essential travel where possible.

With regards to international travel, the evidence on the benefits and disadvantages of various approaches for border closures is being kept under review. UK nationals may be advised against all but essential travel to certain countries or areas during a pandemic through the usual FCO Travel Advice process.

Public health response

Question

19. How will this impact on health services?

Answer

The NHS is used to planning for major emergencies and implementing those plans where necessary. A pandemic is likely to create additional pressures both in terms of responding to the specific demands created by a pandemic and also in maintaining business continuity for care services. We continue to work closely with the NHS and professional organisations to review and improve preparedness measures.

Question

20. Will the NHS be able to cope with the increase in patient numbers?

Answer

Extensive modelling has been carried out to ensure the NHS has robust plans in place for dealing with increased demand for services. Non-essential treatment is likely to be delayed in order to prioritise those patients suffering from pandemic flu. It is also important to remember that we hope treatment will be provided to the majority of pandemic flu cases at home.

Question

21. How many primary care trusts (PCTs) have a pandemic flu contingency plan in place now?

Answer

We expect all NHS organisations to have plans in place and that they are regularly tested and updated. Operational guidance on planning for a flu pandemic was published in autumn 2007. We continue to work with SHAs, PCTs and their partners to ensure that local plans are in place and intergrated with those of other agencies.

Question

22. Have you tested preparedness?

Answer

Health organisations are also required to maintain and test contingency arrangements and are supported in doing so by the Health Protection Agency, who have published an off the shelf pandemic influenza package, Exercise Cold Play, which was commissioned and funded by the Department of Health to assist local organisations to test their own preparedness.  

Self assessment audit tools were issued to the NHS in November 2007 to help them strengthen their pandemic influenza plans.During 2008, NHS organisations will use the tools to self assess their state of preparedness and then use the results to target the areas that need additional development.

The Department (and its Ministers) have also taken part in international and national exercises to test specific aspects of national pandemic preparedness plans The exercises have also proved useful in outlining areas in which more work is necessary.

Question

23. It’s hard enough to get a GP appointment now – how difficult is it going to be when treatment needs to start as soon as possible after symptoms emerge to be effective?

Answer

A flu pandemic is likely to create particular pressure across primary care, community health services, social care and the hospital sector. We are working with the RCGP (Royal College of General Practitioners) and others to look at ways of supplementing and augmenting the ability of general practice to deal with the extra demand in the most effective way. Our operational guidance for care in a community setting includes plans to use support staff who will follow a clinically based algorithm to conduct the initial telephone assessment and to either authorise antiviral supply or refer patients to their general medical practitioner (GP) as appropriate. This should reduce the burden on GPs.

Question

24. What about people living alone – if onset of symptoms is sudden - who can’t get out?

Answer

A flu pandemic is likely to pose challenges to the health and social care system on an unprecedented scale. Health professionals will need to work closely with social care and other statutory and voluntary agencies to provide care for those who are ill. Friends, neighbours and relatives could also make an important contribution.

Question

25. What estimates have been made of the demand for critical care beds in the event of a flu pandemic?

Answer

Although adults with uncomplicated influenza infection do not usually require hospital treatment, patients with worsening pre-existing medical conditions or suffering influenza-related complications such as bronchitis and pneumonia may need referral. Children with severe illness may also need referral for assessment for admission.

Normally, there are some 159,600 beds (including day beds) in use across the UK, of which 3,900 are for patients requiring critical care. Generally, bed utilisation tends to be high (85 percent) and analysis suggests that it would be possible to release almost 33 percent of the total acute bed capacity – almost 40,000 in England – within five to ten days of any decision to cease elective work.

Even with this additional capacity – and the implementation of other measures to improve utilisation and supplement availability – estimates suggest that existing hospital capacity may only meet 20 to 25 percent of the expected demand at the peak. We have therefore issued draft guidance on surge management and prioritisation to assist the NHS in their planning. Final versions will be available in summer 2008.

Question

26. What plans are there to ensure that the NHS has sufficient capacity, including critical care services to deal with the impact of a pandemic?

Answer

A pandemic will undoubtedly lead to major pressures on hospital capacity and we will monitor the situation as a pandemic takes hold; this might mean prioritising people for admission or cancelling elective or non-urgent operations.

Question

27. Will community hospitals be used to treat those suffering with pandemic influenza?

Answer

Most patients will need to be cared for at home. It is for the NHS locally to examine the configuration of services and ensure that they continue to be improved so that we deliver the best possible health care with the best possible value for taxpayers' money.

Question

28. When should I contact my GP?

Answer

In the event of a pandemic if you are ill, or think you may be ill, you will be advised to:
- Stay at home
- Contact the national flu line service – via which you will receive an assessment and be authorised antiviral medicine treatment if symptomatic (unless contraindicated)
- If your symptoms get worse after having contacted the flu line, contact your GP
- Follow self care advice, including:
- Drink plenty of fluids
- Take medicines such as ibuprofen or aspirin to reduce fever and relieve your symptoms (do not give aspirin to children under 16)
- To reduce risk of infection:
- Wash hands frequently (particularly after contact with people who are ill)
- Cover your mouth and nose with a tissue while sneezing or coughing
- Dispose of used tissues promptly and carefully – bag and bin them
- Wash hard surfaces (eg, worktops, door knobs) with a domestic cleaner regularly
- Avoid unnecessary travel
- Avoid crowds where possible
- Ensure your children follow this advice.

Because a pandemic virus will be highly infectious, these measures can only reduce – not stop – the risk of spreading the infection. If you need medical advice or assistance, please telephone the National Pandemic Flu Line (number to be established) as a first port of call.

Question

29. Will I need a prescription for vaccine and/or antivirals?

Answer

We are currently developing legislation to ensure GPs are not overburdened with issuing prescriptions during a pandemic. We are working to ensure that vaccine and antivirals can be administered in the most effective way during a pandemic and hope to produce guidelines shortly.

Question

30. Will there be screening at UK ports?

Answer

The evidence on the benefits and disadvantages of various approaches for screening is being kept under review. Current scientific evidence does not indicate any significant advantage in entry screening. We would consider our position if screening were recommended by WHO, or other countries imposed requirements of this nature.

Question

31. Will masks be made available to the public?

Answer

The Chief Medical Officer commissioned the Health Protection Agency to review the scientific evidence for the use of facemasks by the public during a flu pandemic. This review did not find any clear evidence that such a policy would be of benefit. However, as with all policies relating to pandemic flu, the evidence is regularly reviewed.

We do recognise that people may want to have access to face masks. We will explore the approach that retailers are planning to adopt in stocking facemasks for sale to the public.

Antivirals

Question

32. What are antiviral drugs?

Answer

Antiviral drugs are medicines for the treatment (and sometimes also prevention) of certain viral infections, and are likely to play an important role in treating pandemic flu.

Question

33. Do they cure pandemic flu?

Answer

Treatment with antiviral drugs can be expected to shorten the duration of the disease, alleviate symptoms and reduce complications and serious illness. They are generally well tolerated, but on occasion they can cause nausea and vomiting. More serious side effects are very rare.

Question

34. How are people treated?

Answer

Treatment with antiviral drugs can be expected to shorten the duration of the disease, alleviate symptoms and reduce complications and serious illness. They are generally well tolerated, but on occasion they can cause nausea and vomiting. More serious side effects are very rare. Treatment of pandemic flu should also include rest, ensuring adequate fluid intake and nutrition and taking medications to help with fever and pain such as aspirin (but not in children) and paracetamol. Complications, such as bacterial pneumonia, can develop in some people and can be treated with antibiotics. Those who are severely affected may need hospitalisation.

Question

35. How many antivirals have the UK Government purchased?

Answer

We have purchased enough antiviral drugs to treat twenty five percent of the population. Deliveries were completed in September 2006. We are planning to increase stocks to treat up to 50% of the population (the reasonable ‘worst case scenario’ of how many people could be expected to require treatment).

Question

36. Will antivirals need to be prioritised?

Answer

We are planning to increase our antiviral stockpile from 25% to 50%. This should be enough to ensure treatment for all those that become symptomatic, including in a ‘worst case’ scenario where the maximum predicted attack rate is reached.

In principle therefore, antiviral medicine treatment will be available for all symptomatic patients from the onset of a pandemic. A move to prioritisation of treatment would only be made if scientific information became available to suggest that demand for antiviral treatment would outstrip supply.

Question

37. Can I purchase antivirals privately?

Answer

As we are planning to stockpile a sufficient quantitiy of antivirals to treat fifty percent of the population, personal stockpiling is unnecessary and we would not endorse this. Tamiflu is a Prescription Only Medicine (POM). POMs can only be sold or supplied at a registered pharmacy by or under the supervision of a pharmacist in response to a prescription issued by an appropriate practitioner. There are some exemptions to this (such as supply in accordance with Patient Group Directions) but none cover an individual's purchase of supplies of POMs direct from a manufacturer.

Question

38. Why won't the Government provide antivirals for prophylaxis (prevention) during a pandemic?

Answer

The UK stockpile is intended for treatment only but could also be used for post-exposure prophylaxis in the very early stages of a pandemic in the UK. Sustained use of antivirals for prophylaxis will not represent the best use of our resources, and would reduce the number of people who could be treated. However, we are keeping all possible strategies under review taking into account new information and developments as they emerge.

Question

39. Has Tamiflu (oseltamivir) developed resistance?

Answer

We are aware of the available data on resistance to Tamiflu (oseltamivir). At present, the experience is that these drugs do work and that they should work against a pandemic strain. We will be monitoring the situation closely in relation to our pandemic antiviral strategy, and will seek the views of the Department's Scientific Pandemic Influenza advisory group (SPIag).

Vaccine

Question

40. Is there a vaccine for avian flu?

Answer

We have awarded contracts to Baxter and Chiron to supply 3.3 million doses of H5N1 vaccine and deliveries were completed in September 2006. The move is part of the work to prepare for and reduce the impact of a possible flu pandemic. The H5N1 supplies will be used to conduct further research on the immune responses generated by these vaccines. In the event of a pandemic, these stocks could be used to vaccinate frontline healthcare workers before a specific pandemic vaccine can be developed.

Question

41. How long will it take to develop a specific vaccine?

Answer

A specific vaccine will take at least 4 to 6 months to produce after the pandemic has emerged. The advanced supply contracts for pandemic specific vaccine were signed with Glaxo SmithKline (GSK) and Baxter in July 2007. The contracts are worth in total £155.4 million over four years, and are part of the continued work to prepare for and reduce the impact of a possible flu pandemic. Under these contracts GSK and Baxter are committed to supply a pandemic influenza vaccine to the UK as soon as production commences, once the pandemic strain is identified and made available by the World Health Organisation.

Question

42.  Why can’t we make a vaccine now?

Answer

The virus that causes pandemic flu will be new and a vaccine to protect against it cannot be made until the virus has been identified. Before a pandemic starts it is difficult, if not impossible, to predict what strain will cause it and even then, predictions may prove wrong, or the predicted virus may have changed enough for a pre-prepared vaccine to be ineffective.

Question

43. What is the difference between a vaccine and antiviral drugs?

Answer

Vaccines are usually given as a preventive measure. Currently available viral vaccines are usually made from either killed virus or weakened versions of the live virus or pieces of the virus that stimulate an immune response to the virus. When immunized, the body is then poised to fight or prevent infection more effectively. Antivirals are drugs that may be given to help prevent viral infections or to treat people who have been infected by a virus. When given to treat people who have been infected, antivirals may help limit the impact of some symptoms and reduce the potential for serious complications, especially for people who are in high risk groups.

Question

44. Does seasonal flu vaccine protect against the pandemic virus?

Answer

Currently available flu vaccines only protect against the currently circulating ordinary flu. The virus causing a pandemic will be so different from the strains in the vaccine that they are unlikely to provide any significant immunity in a pandemic situation.

Question

45. Will the vaccine need to be prioritised?

Answer

For pandemic planning purposes, provisional immunisation priority groups have been drawn up. These are subject to ongoing review and cannot be finalised until a pandemic has emerged and specific risk groups determined. Those healthcare workers directly engaged in examination and clinical care of symptomatic flu patients are currently considered the highest priority. This is based on the likelihood of them being at high, and continued, risk of exposure to virus during a pandemic. It will also ensure maintenance of the health service response to a pandemic. As stated, the priority groups will be kept under review based on risk assessments and emerging evidence. Final decisions regarding vaccination priority will be made based on emerging information about the pandemic virus. This is because we cannot know which groups will be affected by pandemic flu until the virus emerges. Once this information is available, the UK National Influenza Pandemic Committee (UKNIPC) will review the priority groups accordingly.

Question

46. How will the vaccine be distributed?

Answer

A pandemic vaccine will be procured and distributed centrally by the Department of Health. This will relieve PCTs and GPs of the burden of procuring vaccine directly from the manufacturers and enable the Government to prioritise its use as necessary.

Bird Flu

Question

47. What is avian influenza (bird flu)?

Answer

Avian influenza (bird flu) is caused by a virus that usually infects birds (particularly poultry) but occasionally crosses the species barrier and infects humans. Experts are particularly concerned about the H5N1 strain of avian influenza which has caused disease and death in birds and has demonstrated the ability to cross the species barrier and cause disease and death in humans.

Question

48. How do people become infected?

Answer

Most cases of H5N1 avian influenza infection in humans have resulted from direct or close contact with infected poultry. For pandemic influenza to occur, avian influenza must mutate to be able to be passed easily from person to person. Pandemic influenza may emerge from the H5N1 strain currently circulating but no one knows when (or if) this will happen.

Question

49. Does seasonal flu vaccine protect against avian influenza?

Answer

No. Influenza vaccine for the 2006-07 season does not provide protection against avian influenza.

Question

50. Can my pets become infected?

Answer

There have been reports in Europe of domestic cats becoming infected with this new strain of H5N1 avian influenza. It would be advisable for owners to stop their pets having contact with other wildlife.