Look out for lethal flu 2.0

The Health Protection Agency (HPA) has warned British medical staff about increasing numbers of flu related secondary infections that “may carry a high mortality”.

In a letter sent on January 10th – midst the hectic flu season – the Chief Medical Officer, Professor Dame Sally C. Davies, informs UK GPs and medical organs how to handle a new spread of deadly viruses.

“Dear Colleagues, I write to alert you to an increase in a number of significant bacterial infections such as those caused by Neisseria meningitidis (meningococcal disease) and others that may occur as co-infections with flu,” Davies writes.

The letter states that pathogen streptococcal bacteria – which can cause sepsis, meningitis and childbed fever – can “progress to severe illness rapidly” and affect those otherwise unlikely to get flu and who are not included in influenza risk groups for seasonal vaccination.

HPA data shows that the number of people infected with invasive Group A Streptococcal (iGAS) viruses was 37% higher in December 2010 compared to the same month previous year – with 164 reported cases in the last month of 2010, up from 103 in 2009.

Meningococcal disease saw an increase as well – from 88 to 150 cases – although it seems to have been at a particularly low level in the previous year.

“People don’t die of flu itself, they die of secondary infections, which are invasive bacterial infections they can get while having flu,” says HPA press secretary Alex Baker.

“But those bacteria can also spread to people who doesn’t have flu and bring serious diseases, some of which can be deadly because they spread so quickly.”

“People with bad lungs or heart are more at risk of developing secondary infections, so asthmatics, who have problems with optimizing their use of oxygen and lung function might risk developing pneumonia or an infection that attacks those mechanisms,” Baker explains.

Deborah Goodhart, Head of Communications at Whittington Hospital, says: “So far we’ve been spared from any increases in secondary infections. We are at the same levels as we were last year and the year before. We’re very, very lucky, other places have been more affected, but we’re prepared incase these viruses do start to spread significantly.”

On January 20th, 254 deaths caused by influenza had been reported this season, according to the HPA’s weekly flu report. A majority of those were due to the H1N1 (Swine flu) virus. However, the number of people dying of flu related diseases, such as pneumonia and meningitis, usually reaches up to 5,000 per season – figures that are now expected to rise.

“Ongoing HPA surveillance continues to indicate a modest increase in cases of some invasive bacterial infections such as pneumococcal and meningococcal disease and iGAS infection which may follow on from or be associated with influenza,” says professor John Watson, head of the respiratory diseases department at the HPA.

“Although we expect to see more cases of these bacterial infections during the winter months the HPA is monitoring the situation closely and currently investigating whether co-infection with flu is contributing to these increases.”

HPA Press Officer Baker says: “If you’re not in a risk group and try to avoid flu, because there is a high risk of secondary infections which is quite common with flu, it’s good to take your vaccination.”

April 2010 saw the introduction of a new vaccine giving protection to for some secondary infections. But people do still feel unsafe due to new alerts.

“I am slightly worried for my family. But then again, being pregnant you always worry a bit extra about everything. I’ve been vaccinated, but you’re being warned for so many diseases I barely know what the jab was for. My oldest son hasn’t been vaccinated, he’s not in a risk group, but I guess with these new infections we’ll have to sort that out,” says soon to be mother of three, Diane Whittaker, Highgate.

In the meantime, the Department of Health (DH) reports that the amount of patients being treated in critical care beds is decreasing. Since January 13th the number has reduced from 661 patients to 418 on January 20th.

“Our latest flu report suggests levels of flu are declining across the UK but nonetheless flu is still circulating in the community and the message remains that people in an at-risk group should get the seasonal flu vaccine,” says Professor Watson.

DH data of week 2, 2011, shows that 71,7% of people in risk groups above 65 years of age have been vaccinated, while merely half (48%) of under 65s in risk groups have done the same. In both groups the numbers are going down compared to same period 2010, despite the incidence rate being five times as high as last year.

“As the cases of flu goes down, we expect to see more cases of bacteria infections during these winter months because it’s the normal time when these infections circulate,” says Baker. “So it’s not unusual to see these two things [influenza and secondary infections] circulating together. But people should be aware that there’s a higher risk at the moment.”

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