ANALYSIS:IRELAND IS now experiencing a significant increase in the rate of pandemic (H1N1) infection. This is now a national public health emergency and today, a significant phase of our response formally commences with the official roll-out of our mass vaccination plan, beginning with those in the ''at risk'' groups, writes TONY HOLOHAN
These are people between the ages of six months and 65 years who have chronic lung, heart, kidney, liver or nervous system disorders. It also includes women who are pregnant or people who have reduced immunity either as a result of a disease or a medication.
All the measures that we use to track rates of influenza are increasing. We are seeing influenza now occurring at rates we have never seen before with seasonal influenza. This is particularly the case among children. The coming weeks are critical. Influenza activity will increase affecting many in the population. Our health system is well prepared, and we are now commencing our vaccination programme which will be implemented across the population.
At this point, we estimate that about 2.5 per cent of the population have been infected. The assumption which we have used to inform our planning is that the first wave could lead to infection of 25 per cent of the population. While this figure may not turn out to be this high, there will certainly be further increases in hospitalisations and deaths in the coming weeks and months.
Our ability to adequately respond as a society will depend not only on the extent to which plans are in place but much more so on our collective ability, as individuals, communities, sectors of society, and professionals, to work together to ensure that these plans are realised. We are still likely to see a significant impact on our health system, on schools and on other sectors and on business.
It is reassuring that H1N1 influenza is a mild infection in the majority of people. Most people make a full recovery by looking after themselves at home, drinking fluids and taking medication to control temperature and other symptoms.
Some people will need to visit their GP to get antiviral medication or other medication to manage complications. Fewer than one in a hundred people require admission to hospital to manage their symptoms. Some of these people will require temporary assistance with mechanical ventilation. Complications are more likely among people with underlying medical risks, in pregnancy and among younger children.
We must not be complacent. H1N1 shows some important differences in behaviour from seasonal influenza. Significant complications can and do arise among people who are otherwise healthy. The experience in Ireland so far has shown that more than half the almost 500 people who have required admission to hospital do not have an underlying illness.
There is no way of predicting how people who experience complications are likely to be.
People in Ireland can take comfort from the fact that we are well prepared by international standards. The plans that are in place are based on preparations that began as long ago as 2005 to deal with the emerging international concern in the wake of SARS and in relation to Avian (H5N1) Influenza. The international and national response systems that have been developed as a result have allowed us to respond rapidly to a changing and dynamic situation.
We have been able to secure sufficient supplies of vaccine. Our intention has been to get the basic messages to people in relation to the symptoms of H1N1 and how they should try to manage it and how, and when, to seek help.
We have a skilled and dedicated workforce in the health system. GPs, emergency departments, nursing services, intensive care units, public health officials and others have been in the frontline of our response since the start and have managed very well. Guidelines have been changing as our understanding of the disease develops and each time our health professionals have absorbed those changes and acted accordingly.
We have worked very closely with other sectors such as education. The rates in school children suggest that there must be significant absenteeism occurring in schools – but schools seem to be managing well based on the reported number of school outbreaks. Credit is therefore due to the parents, teachers, principals, boards of management and the Department of Education for responding so well to these challenges in a measured and balanced way.
People can protect themselves and others by ensuring that those with symptoms stay out of work, school or other social setting for seven days after the onset of symptoms and by following the advice to always use a clean tissue when coughing or sneezing, which is then disposed of and to always wash hands thoroughly.
Now the priority is vaccination. It is the most effective means of preventing the spread of infection. The rates of infection in the population are such that we must ensure that we offer this vaccine as soon as practicable to as many people as our vaccine supplies will allow.
Initially vaccination is being offered to those people who are clinically at highest risk of developing complications of H1N1, as outlined above. These people who are clinically at high priority are being vaccinated for the most part through their GP. This is the most appropriate place for them to be vaccinated as their GP is familiar with them and their condition and, indeed, they are familiar with their own GP. Over 200,000 doses of vaccine have been made available to GPs over the last two weeks and many people in these groups will have already received their vaccine.
In some cases, where a GP has chosen not to participate in the programme, he will be able to direct the patients among this group to HSE-run clinics.
The times and locations of these clinics have been provided to all GPs and are available also through www.swineflu.ie.
Young children, school-going children and people over the age of 65 will be vaccinated shortly.
Healthcare workers will be immunised in the coming weeks in parallel with the vaccination of high-risk people.
Ireland has two vaccines available which have been licensed by the European Medicines Agency. Vaccination will not give you the flu, but may lead to some soreness, swelling and redness in the area of the injection.
In some people, it can cause more generalised symptoms including temperature rises, difficulty sleeping, aches and pains. These symptoms resolve within one to two days. In a very small number of people it can lead to an allergic reaction. Doctors and nurses giving the vaccine will need to be prepared to deal with patients who experience these symptoms.
I understand that some people may be concerned about taking a new vaccine. The overwhelming medical and scientific advice, both national and international, is that benefits far outweigh any risks associated with the vaccine. I would urge people to come forward for vaccination in line with the recommendations and prioritisation as set out in our national plan which will continue to be communicated throughout our campaign.
Dr Tony Holohan is chief medical officer with the Department of Health. This information continues to be available through www.swineflu.ie and 1800 941100