The Health Protection Surveillance Centre is urging all parents to make sure that their children are vaccinated against measles following a national outbreak of the disease which has caused a number of children to need hospitalisation.
The outbreak which started in August, is continuing, and there are real concerns about spread among non-vaccinated individuals. A majority of cases this year have occurred among children from the Traveler community.
Measles is highly infectious and can cause severe illness and occasionally cause death. An outbreak in 2000 resulted in more than 1600 cases and three deaths.
As vaccination with the MMR is the only way to prevent measles infection, all parents must make sure their children have received the recommended two doses of the vaccine. While the first dose is usually given at 12 months of age by GPs and the second in school at 4-5 years of age, the vaccine can be received at any time. Anyone who is not sure about their vaccination status should get another dose, which will not do them any harm, and will protect against measles, mumps and rubella.
Further information on the measles outbreak is available in a recent HPSC press release and measles articles in January's issue of Epi-Insight and the March issue of Eurosurveillance.
ESCAIDE 2009
The 2009 European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE 2009) organised by ECDC takes place in Stockholm, Sweden on 26-28 October 2009.
The conference aims at: (a) strengthening and expanding the human network of all involved in applied infectious disease epidemiology (b) sharing scientific knowledge and experience in this field in Europe and internationally, and (c) providing a dedicated platform for EPIET/FETP (field epidemiology training programme) fellows to present their work.
The target audience for the conference includes epidemiologists, microbiologists, clinicians and public, veterinary and environmental health experts with a professional and scientific interest in applied infectious disease epidemiology. For further information see the ESCAIDE 2009 website
Pandemic (H1N1) 2009 Update
Weekly Update on01/10/09 at 17:00
Please refresh any webpage you visit to ensure you are seeing the most current version.
Most people with pandemic influenza will have relatively mild symptoms, they will not need any antiviral medication and will recover by staying at home (to prevent spreading infection to others), drinking plenty of fluids and taking paracetamol regularly to relieve their symptoms. Antiviral medication is generally recommended only for people in certain at-risk groups (see below) and those who are severely ill.
The approach to managing the current influenza situation has moved from one of containment (or limiting the entrance and initial spread of Pandemic (H1N1) 2009 into the country) to one of mitigation (or minimising the impact of the flu virus as its circulation increases). This is an approach that has been adopted in most countries now. It is important to remember that the vast majority of cases that have been seen so far are mild with many cases possibly unaware that they have been infected. (See here for information on the symptoms of influenza and advice on the how to look after someone who has flu).
Pandemic (H1N1) 2009 can however cause problems in people in certain at-risk groups, and these include people with chronic respiratory, heart, kidney, liver or neurological disease; immunosuppression (whether caused by disease or treatment); diabetes mellitus; haemoglobinopathies; people aged 65 years and older; children under 5 years old; people on medication for asthma, severely obese people (BMI ≥40) and pregnant women.
The current strategy targets resources towards ensuring appropriate treatment of cases and providing clear information to the public on prevention and on what to do if they become ill. In particular, resources are focused on the protection and early treatment of people who may be at risk of more severe illness.
Health Professionals: should visit the section of the HPSC website providing Advice for Health Care Staff for important clinical and public health information, including algorithms to guide patient management.
Case Numbersand Latest News: Case numbers are being reported on a weekly basis and are available here. The most recent report from ECDC on Pandemic (H1N1) 2009 worldwide is available from the ECDC website here. The World Health Organization's Weekly Pandemic (H1N1) 2009 update is available at the WHO Disease Outbreak News section here.
Travel: The current travel advice of the Department of Health and Children is available here.
Symptoms of Influenza: The symptoms and signs of influenza are available here. If you develop an influenza-like illness, you should stay at home and telephone the HSE Flu Information Line on Freephone 1800 941100. If you have severe symptoms, or are in a high risk group, contact your GP/family doctor by telephone.
Specialist Information: Pandemic Influenza Preparedness for Ireland: Advice of the Pandemic Influenza Expert Group is available here. The National Pandemic Influenza Plan is available here. For further information for health professionals see here.
Pneumococcal vaccination for individuals at increased risk - algorithm for health professionals may be found here
Influenza vaccine requirements for Hajj 2009/10
Seasonal influenza The Ministry of Health of Saudi Arabia has announced an important addition to the health requirements for pilgrims attending Hajj and Umrah during the 2009/10 season. All pilgrims intending to take part in this season’s Hajj must provide a valid certificate of vaccination against 2009/10 seasonal influenza when applying for a Hajj visa. The vaccine must be administered at least two weeks before arrival in Saudi Arabia.
Pandemic influenza A valid certificate of vaccination against Pandemic (H1N1) 2009 (again of at least two weeks’ standing), if such vaccination is universally available, must also be provided before acquiring a Hajj visa.
Prospective pilgrims for Hajj and Umrah are further advised that the elderly and persons with chronic diseases, children and pregnant women should postpone the Hajj and Umrah pilgrimages this year for their own safety.
Meningococcal Meningitis Incoming travellers for Hajj or Umrah or for seasonal work in the areas of Hajj from any country are required to have a valid certificate of vaccination against Meningococcal Meningitis stating that the traveller has been vaccinated at least 10 days earlier and no more than 3 years prior to their arrival in the Kingdom. Vaccination with a single dose of the tetravalent vaccine against ACYW135 is required for all adults and children over the age of 2 years.
European Scientific Conference on Applied Infectious Disease Epidemiology, Stockholm, October 2009
The 2009 ‘European Scientific Conference on Applied Infectious Disease Epidemiology’ (ESCAIDE 2009) will take place in Stockholm, Sweden, 26-28 October 2009.
The call for abstracts will open on 24th April and close on 3rd July. Abstracts are welcomed in the area of applied public health research, outbreak investigations and evaluation of public health surveillance. Also welcomed are abstracts in other areas in applied epidemiology or public health practice in which results are linked to public health action.
HSE offers MMR Vaccine to post Junior Cert students as Mumps cases continue to increase
The Health Service Executive (HSE) today announced that it will offer MMR vaccination to Transition, 5th and 6th Year students in secondary schools nationwide before the summer break. This measure is being taken in response to continued increases in cases of mumps in older teenagers and young adults across the country.
Dr Brenda Corcoran from the HSE’s National Immunisation Office today said ‘Outbreaks of mumps have become increasingly frequent in those aged 15 to 24 over recent years, and from January 2009 to date. There has been a huge increase in notifications reported to the Health Protection Surveillance Centre – 1957 compared to 128 for the same period in 2008.’
Mumps is an acute viral illness that causes fever, headache and painful, swollen salivary glands. It requires isolation or quarantine, and can cause people to miss up to two weeks from school, work, studying, taking exams or socialising. Generally complications are mild but mumps can cause meningitis, deafness or inflammation of the pancreas or testicles. MMR vaccine provides protection from mumps, as well as measles and rubella.
Dr Corcoran explained ‘This outbreak is happening because there are lots of older teenagers who have not had two doses of MMR vaccine and so are at risk of getting mumps. Outbreaks of mumps have been reported in secondary schools, colleges, universities, and sports clubs – that’s why we’ve decided to offer this group a dose of MMR. It will protect them now, and when they leave school.’
Teams from HSE Public Health Departments and Local Health Offices will contact second level schools across the country this week to schedule immunisation clinics in schools in the coming weeks. MMR vaccine will be provided to all those in Transition, 5th and 6th years, free of charge, protecting those who get the vaccine from contracting mumps.
The National Immunisation Advisory Committee, a committee of independent immunisation experts supports the HSE campaign to control this outbreak and to prevent future ones.
Recent studies estimate that one dose of MMR is approximately 80% effective and estimates for two doses of MMR range from 88-95% effective in preventing mumps illness. If a young person’s MMR history is not known, an extra dose of MMR will do no harm, and could offer valuable protection against mumps.
The HSE will be attending as many schools as possible in the weeks before the summer break, and any schools that are not targeted will be followed up in September. In addition, the HSE continues to advise those in 3rd level institutions to attend Student Health services for MMR vaccine.
More information is available from www.mumps.ie or the HSE infoline 1850 24 1850.
Continued increase in mumps cases in 2009
The number of individuals affected by the mumps outbreak is increasing, with 843 cases notified to the Health Protection Surveillance Centre since the beginning of the year (as of 4/3/09); 453 cases were notified in February alone, the greatest number reported in any one month period since the outbreak began in 2004. (Figure 1)
Those most affected by mumps are between the ages of 15-24 years (66.5%). (Figure 2) Slightly more males (54.8%) than females have been reported. Information on hospitalization status was available on 330 cases, of whom 14 cases have been hospitalized (for orchitis and/or pancreatitis and unspecified reasons), all were male. Vaccination status was reported for 41% of all cases (n=336); of whom 25% were unvaccinated, 29% were incompletely vaccinated and 46% reported two doses of vaccine (complete vaccination).
Since the beginning of 2009, 16 new outbreaks have been reported, colleges/universities, and other educational facilities (school, crèche). These are in addition to already recognized community wide outbreaks reported in 2008 when 18 outbreaks were reported in university or third level colleges, seven school outbreaks were reported and one outbreak in a crèche. Workplace outbreaks were also reported in 2008.
The mumps outbreak in Ireland demonstrates similar characteristics to outbreaks reported in other developed countries; England, the United States, and Canada. All these countries have reported large mumps outbreaks in recent years, most notable in colleges and third level academic institutions. Outbreaks have been particularly common in those countries or areas with low MMR coverage, and are affecting students in age groups many of whom are incompletely vaccinated. Some outbreaks have been reported in highly vaccinated populations (United States) but the numbers are substantially less than that reported in countries with low immunization rates. In areas where outbreaks have occurred, and where targeted action has successfully improved MMR uptake, the outbreaks have been controlled. A combination of primary vaccine failure (failure to develop immunity after the vaccine) and waning immunity may both have a part to play in these outbreaks now being seen in developed countries.
Figure 1. Mumps notifications by month and year (01/2001-02/2009*)
CIDR: data downloaded 04/03/2009 at 16:45 hours. Provisional data for 2008/2009
Figure 2. Mumps notifications by age group (2009*)
Protecting against mumps Mumps vaccination, available in the MMR vaccine is the best preventive method to prevent mumps and its associated complications. Recent studies published in international literature estimate that one dose of MMR is approximately 80% effective and estimates for two doses of MMR range from 88-95% effective in preventing mumps illness.
All individuals less than 25 years of age are recommended to ensure that they have had two doses of MMR. If they do not have vaccination records documenting two doses they are advised to seek MMR vaccination from their GP or other health provider (e.g. student health service for students). The MMR vaccine is free to this age group. Payment for the GP visit may be required for non medical card holders. Student health services are free.
Individuals older than 24 years are usually immune from mumps as a result of natural infection. However, if individuals in older age groups wish to receive MMR vaccine this can be obtained from the GP. There is no upper age limit to the MMR vaccine.
References
Dayan GH, Quinlisk PM, Parker AA, Barskey AE, et al. Resurgence of Mumps in the United States. NEJM 2008 358(15); 1580-1589
Rubin SA, Qi L, Audet SA, Sullivan B, Carbone KM, Bellini WJ, Rota PA, Sirota L, Beeler J. Antibody Induced by Immunization with the Jeryl Lynn Mumps Vaccine Strain Effectively Neutralizes a Heterologous Wild-Type Mumps Virus Associated with a Large Outbreak. The Journal of Infectious Diseases 2008; 198:508 –15
Cohen C, White JM, Savage EJ, Glynn JR, Choi Y, Andrews N, et al. Vaccine effectiveness estimates, 2004–2005 mumps outbreak, England. Emerg Infect Dis [serial on the Internet]. 2007 Jan [date cited]. Available from http://www.cdc.gov/ncidod/EID/13/1/12.htm
Mossong J, Bonert C, Weicherding P, Opp M, Reichert P, Even J, Schneider F. Mumps outbreak among the military in Luxembourg in 2008: epidemiology and evaluation of control measures. Euro Surveill. 2009;14(7):pii=19121. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19121
Mumps cases exceed 1000 in 2008
Teenagers and young adults have been warned by the Health Protection Surveillance Centre to make sure that they have had two doses of MMR vaccine following over 1000 cases of the disease in 2008.
1166 cases have been reported so far compared with 132 for the same period last year. Dr Suzanne Cotter, Specialist in Public Health Medicine, HPSC advised that MMR vaccination is the only way to tackle this increase.
The huge rise in cases – nearly 60% of whom are between 15 and 24 years old - highlights once again the importance of getting vaccinated with two doses of MMR, which are needed to minimize the risk of infection. This is especially important for all teenagers and young adults, particularly students in schools and colleges following at least seven outbreaks in third level colleges this year.
Anyone who has not had two doses of MMR needs to talk to their GP or student health service about getting protected. People who are not sure about their vaccination status should get another dose to be on the safe side. The vaccine is free although an administration fee may apply for non-medical card holders.
Mumps is a contagious acute viral illness that causes fever, headache and painful swollen glands. Complications are usually mild but it can cause meningitis, deafness and inflammation of the testicles, ovaries or pancreas. Students need to be aware that the best way to avoid it is to get vaccinated. Anyone who has mumps should stay off for five days after the onset of swollen glands.
During week 6 2009 (February 2nd to 8th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland decreased to 15.9 per 100,000 population. This rate is below the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland). The use of antivirals drugs for the prevention or treatment of influenza in at-risk groups is no longer recommended as per the National Institute of Clinical Excellence (NICE) guidelines, UK Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007-like virus which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 6 is available here.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance is outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenza season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
Don't be late - vaccinate! Pneumococcal conjugate vaccine - catch-up campaign for children
All children born between 2nd September 2006 and 30th June 2008 are due the pneumococcal conjugate vaccine. This vaccine offers protection against pneumococcal infections such as meningitis and pneumonia. Both of these diseases are more common in winter months. Young children are at particular risk of pneumococcal disease and vaccination with the conjugate vaccine will protect against the most common forms of pneumococcal disease.
The vaccine is free of charge and is provided by the GP.
All parents should make a GP appointment for their child so that the vaccine can be given. Don't be late - vaccinate!
The catch up campaign will run until 31st October 2009.
Increase in Influenza-like Illness
During week 5 2009 (January 26th to February 1st), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland decreased to 34.6 per 100,000 population from a rate of 42.9 per 100,000 during week 4. These rates remain higher than the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland) above which the use of antiviral drugs is triggered. The ILI rate decreased in all age groups except in those aged 5 to 14 years where the rate remained stable. Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007-like virus which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 5 is available here.
Due to the current level of influenza activity seen in Ireland, antiviral drugs for the prevention and/or treatment of influenza in at-risk patients continues to be recommended in line with the National Institute of Clinical Excellence (NICE) UK guidelines.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance is outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenza season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
Training Fellowships for Intervention Epidemiology in Europe
ECDC plans to recruit 20 applicants for the 15th cohort of fellows in the European Programme for Intervention Epidemiology Training (EPIET).
The European Programme for Intervention Epidemiology Training (EPIET) is a two-year fellowship programme, which provides training and practical experience in intervention epidemiology at the national and regional centres for surveillance and control of communicable diseases in the European Union (EU) and Norway. The programme is aimed at EU medical practitioners, public-health nurses, microbiologists, veterinarians and other health professionals with previous experience in public health and a keen interest in epidemiology. It trains EU fellows in the core skills required for the investigation and control of communicable disease threats in and beyond Europe.
Detailed information about the EPIET programme can be obtained from the EPIET programme website at www.epiet.org
During week 4 2009 (January 19th to 25th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland decreased to 43.4 per 100,000 population from a rate of 100.6 per 100,000 during week 3. These rates remain higher than the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland) above which the use of antiviral drugs is triggered. The ILI rate decreased in all age groups. Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007-like virus which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 4 is available here.
Due to the current level of influenza activity seen in Ireland, antiviral drugs for the prevention and/or treatment of influenza in at-risk patients continues to be recommended in line with the National Institute of Clinical Excellence (NICE) UK guidelines.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance is outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenza season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
During week 3 2009 (January 12th to 18th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland decreased to 103.1 per 100,000 population from a rate of 120.5 per 100,000 during week 2. These rates are significantly higher than the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland) above which the use of antiviral drugs is triggered. The ILI rate decreased in all age groups except for the 5 to 14 year age group where a slight increase was noted. Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007-like virus which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 3 is available here
Due to the current level of influenza activity seen in Ireland, antiviral drugs for the prevention and/or treatment of influenza in at-risk patients continues to be recommended in line with the National Institute of Clinical Excellence (NICE) UK guidelines.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance is outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community. http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine As influenza-like illness rates are increasing and influenza A is circulating, it is also important that persons in at-risk groups for influenza are vaccinated as these groups are at higher risk of developing complications from influenza.
Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenza season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
During week 2 2009 (January 5th to 11th), the general practitioner consultation rate for influenza-like illness (ILI) in Ireland increased to 120.5 per 100,000 population from a rate of 100.2 per 100,000 during week 1. Both rates are significantly higher than the Irish baseline threshold of 17.8/100,000 (to assess influenza activity during the 2008/2009 influenza season in Ireland) above which the use of antiviral drugs is triggered. The rate of increase was most pronounced in the 15-64 year age group with increases also noted in those aged 65 years and over. Genetic characterisation of the two influenza A (H3) viruses identified this season confirms them to be A/Brisbane/10/2007-like virus which is included as a component in the 2008/2009 influenza vaccine. The flu report for week 2 is available here
Due to the current level of influenza activity seen in Ireland, antiviral drugs for the prevention and/or treatment of influenza in at-risk patients continues to be recommended in line with the National Institute of Clinical Excellence (NICE) UK guidelines.
A summary of the NICE guidelines for the use of antiviral drugs for the treatment or prevention of influenza in at-risk patients is available here.
The complete NICE guidance is outlined below: Recommendations on the use of antiviral neuraminidase inhibitors for the treatment of influenza when influenza is known to be circulating in the community. http://www.nice.org.uk/Guidance/TA58.
Influenza Vaccine As influenza-like illness rates are increasing and influenza A is circulating, it is also important that persons in at-risk groups for influenza are vaccinated as these groups are at higher risk of developing complications from influenza.
Risk groups for influenza vaccine are outlined below as per the Immunisation Guidelines for Ireland 2008 (Chapter 7). They are as follows:
Those older than 6 months of age who are at increased risk of influenza-related complications including the following groups:
Persons aged 50 years or older as recommended by WHO*
Those with chronic illness requiring regular medical follow-up (e.g. chronic respiratory disease, including cystic fibrosis, moderate or severe asthma, chronic heart disease, bronchopulmonary dysplasia, diabetes mellitus, haemoglobinopathies, chronic renal failure, etc.)
Immunosuppression due to disease or treatment, including asplenia or splenic dysfunction
Children on long-term aspirin therapy (because of the risk of Reyes Syndrome)
Children with any condition (e.g. cognitive dysfunction, spinal cord injury, seizure disorder, or other neuromuscular disorder) that can compromise respiratory function
Residents of nursing homes, old people’s homes, and other long-stay facilities where rapid spread is likely to follow introduction of infection
Those likely to transmit influenza to a person at high risk for influenza complications (including household contacts and out-of-home caregivers)
Healthcare workers, both for their own protection - as these are a group likely to come in contact with influenza during outbreaks - and for the protection of their patients
Poultry workers, veterinary inspectors, agricultural workers, park rangers and those with likely contact with water fowl (as this puts them at risk of co-infection with avian influenza)
Pregnant women in the risk groups 2 and 3 listed above should be vaccinated before the influenza season, regardless of the stage of pregnancy. Studies indicate that pregnancy may increase the risk of complications from influenza because of the alterations in heart rate, lung capacity and immunological function. It is estimated that immunisation could prevent 1-2 hospitalisations per 1,000 pregnant women. Because influenza vaccine is not a live vaccine it is considered safe in pregnancy.
*Currently HSE are implementing this in those aged 65 years and over
The Health Protection Surveillance Centre urges people in high-risk categories to get vaccinated against influenza, as the number of reported cases of influenza-like illness (ILI) in Ireland continues to rise.
ILI rates have risen from 72.8 per 100,000 in the last week of December 2008 to 100.6 per 100,000 in the first week of January 2009. This is the highest rate seen since the 2000/2001 influenza season.
"As influenza continues to circulate in the community, it is important that people in high-risk categories get vaccinated against influenza," says HPSC specialist in public health medicine, Dr Derval Igoe.
“High-risk groups are:
The over 65s
People including children with chronic illness requiring regular medical follow-up such as chronic lung disease, chronic heart disease, and diabetes
Those with lower immunity due to disease or treatment, including those who have had their spleens removed
Children or teenagers on long-term aspirin therapy
Residents of nursing homes, old people's homes and other long stay facilities
Health care workers and carers of those in risk groups.
“Health Professionals should use antiviral drugs for the treatment or prevention of influenza in high-risk groups.
“The symptoms of influenza usually develop over a matter of a few hours and include a high temperature, sore muscles, dry cough, headache and sore throat. This is different from the common cold, which tends to come on more gradually and usually includes a runny nose and a normal temperature.
“Anyone who gets flu should stay at home, rest, drink plenty of fluids and use over-the-counter remedies like paracetamol to ease symptoms. People in high-risk categories should contact their GP if they develop influenza symptoms.
“Covering your nose and mouth with a tissue when you cough and sneeze, disposing of the tissue as soon as possible and washing your hands with soap and water as soon as you can are important measures in helping prevent the spread of flu,†added Dr Igoe.
ILI rates give an indication of the overall level of influenza activity in Ireland and are reported by selected GPs as part of a surveillance system jointly run by the Irish College of General Practitioners, the National Virus Reference Laboratory and the Health Protection Surveillance Centre.
New national guidelines for the control of Legionnaires disease are available here.
The 2009 ‘European Scientific Conference on Applied Infectious Disease Epidemiology’ (ESCAIDE 2009) will take place in Stockholm, Sweden, 26-28 October 2009.
