Lois Rogers

Journalist and Communicator

Australian flu threatens Britain

Health, Infection

http://subscriber.telegraph.co.uk/news/0/australian-flu-prevent-virus-symptoms-look/

The super-charged Australian flu virus sweeping Britain has been busy claiming alarming numbers of victims and creating an NHS crisis on a new scale.

In what is now shaping up to be the country’s worst flu crisis in 20 years, 85 people have died so far this winter. In the first week of the year, flu cases accounted for 22,000 visits to GPs, with 114 sufferers reported as fighting for their lives in intensive care.

Among the victims was 18-year-old Bethany Walker, from Applecross, Scotland, who died after her flu symptoms developed into pneumonia.

More than three million people at high risk of flu have not yet been vaccinated despite the biggest wave of “public fear” since swine flu in 2009, health chiefs have said.

A letter sent to every GP practice in England warns they have just two weeks left in which to vaccinate patients against this winter’s virulent outbreak, which has already claimed 85 lives and is threatening to become an epidemic.

Hospitals are already operating at capacity, but medical experts suggest that this hyper-virulent flu strain has barely got started.

The new strain has spread throughout the UK exactly 100 years after Spanish flu, the world’s worst pandemic, killed upwards of 50 million people worldwide

Chemists were running low on supplies of the flu vaccine on Friday amid growing fears of an epidemic if the virus continues to spread at its current rate.

After reports of a shortage in Cumbria, the Telegraph contacted branches of Boots across the Midlands, East of England, the South and South West, but all 10 branches had no jabs left. Last night Boots UK said the shops would today be resupplied.

According to figures released on Thursday, one in five people hospitalised with flu is suffering from the deadly strain – and if it continues to spread at its current rate, Britain will be in the grip of a flu epidemic by the end of the month.

With its roster of telltale symptoms – sudden fever, aching body, sore throat, exhaustion, difficulty sleeping, loss of appetite – Australian flu sounds familiar enough.

However, it is the strain’s ferocity, coupled with its unusually long recovery time (flu symptoms tend to subside after a week or so, but H3N2 – the so-called “Aussie” strain – can last much longer), the low-level effectiveness (20-30 per cent) of the current vaccine and the vastly increased potential for fatalities that have marked it out.

When H3N2 hit Australia last year, during their winter, it led to its worst flu season for nearly a decade. The 72 reported deaths went well beyond the high-risk vulnerable group of young babies and the chronically sick and elderly.

They included a mother-of-two in her thirties, a young father, an eight-year-old girl and an 18-year-old law student. Some 217,000 people were infected – many times more than the previous record of 100,000 reported flu cases in Australia in 2015.

The new strain has spread throughout the UK exactly 100 years after Spanish flu, the world’s worst pandemic, killed upwards of 50 million people worldwide. The threat of a repeat crisis on a similar scale is not far from the minds of experts today.

“The 1918 virus has been reconstructed and has shown itself to be very virulent in animal models,” says Professor Wendy Barclay, an expert in virology at Imperial College in London. “We will get another similar virus again and we will potentially have another pandemic. We hope not – but we can’t exclude the possibility.”

Flu virus mutates at random, producing a shape-shifting pathogen that can suddenly acquire deadly virulence.

Our last big flu epidemic was in 2009, when 138 people died and more than 540,000 were hit by swine flu, a virus incubated in pig-rearing facilities in Mexico.

Intensively farmed pigs and poultry are particularly susceptible to flu outbreaks, with crowded living conditions providing a perfect environment for the development of mutations that can readily cross species into humans, potentially causing a new and deadly global pandemic to match the 1918 disaster.

“There is always the potential for viruses to emerge from animal sources,” says Prof Barclay. “It is not something you can accurately predict.”

“The basic problem is the instability of the flu virus,” says Professor Robert Dingwall of Nottingham Trent University, a former member of the Government’s flu pandemic planning committee. “All we can do is take the best guess on what strains have been around for the past two years.

“Australian flu is not new, but vulnerable people don’t seem to be responding as well to the vaccine as we might have hoped, and so it’s more serious.”

Vulnerable people don’t seem to be responding as well to the vaccine as we might have hoped

He believes the false sense of security following many winters of relatively low-level flu infection could also have disastrous consequences. “We may well have a worse flu season than we have had for some years, with more deaths and more hospitalisations.”

Here, then, is what you need to know about Australian flu – and how to better protect yourself against it.

What exactly is flu?

It is a group of viruses that attach to the lining of the lungs. The symptoms of high fever, nausea, vomiting and diarrhoea are side-effects of inflammation caused as the immune system goes into overdrive to fight it off.

The virus is divided into A, B, C and D categories, depending on its capacity for mutation and infection. Types A and B are the most dangerous to humans.

The letters “H” and “N” in the strain refer to up to 18 types of haemaglutinin protein and 11 types of neuraminidase protein on the surface of the virus.

These proteins affect the ability of the virus to attach itself to the lining of the lungs.

How is this Australian flu strain different?

The H3N2 type A strain – which has been nicknamed Australian flu because of where its outbreak was first reported – is similar to the H3N2 Hong Kong flu that caused a worldwide pandemic in 1968, killing an estimated one million people worldwide.

Public Health England (PHE) says another strain, H1N1pdm09 type A, is also currently causing high levels of infection in Britain. This strain is similar to (but much less dangerous than) the 1918 H1N1 Spanish flu, and is a form of the swine flu first reported in the last 2009 pandemic.

Many other current notified flu infections have not yet been fully typed.

Why is it called Aussie flu?

The influenza virus can change every year, which means the flu you contract this year could be a different type to the one you suffered from last year.

While the official name of the flu circulating the UK this winter is H3N2, it has recently been dubbed Australian – or Aussie – flu. This is because the same strain fuelled the worst flu crisis Australia had experienced for around two decades.

The colloquial names given to different flu strains can be based on:

  • the year of discovery or isolation
  • where the flu originated
  • the strain number
  • which animal the flu originated from (for example, swine flu)

The particular strain of H3N2 flu that is affecting the UK is similar to the type that Australia suffered from earlier this year, during their winter.

Over 217,000 Australians had confirmed cases of the virus in 2017, over double the previous record of just over 100,000 in 2015.

What are the symptoms?

Dr Richard Pebody, acting head of respiratory diseases at Public Health England, said the H3N2 influenza can cause problems for the elderly – and can particularly result in care home outbreaks.

According to the NHS, the symptoms to look out for in adults include:

  • a sudden, high fever, with a temperature of 38C or above
  • aching body
  • feeling tired or exhausted
  • dry, chesty cough
  • diarrhoea or tummy pain
  • sore throat
  • nausea and being sick
  • headache
  • loss of appetite
  • difficulty sleeping

Children can also suffer from earache when they have the flu.

Why has Australian flu struck now?

Flu viruses travel round the world causing most infections in winter. Prof Dingwall says it is not clear if Australian flu is causing more of a problem because it’s more virulent, or whether we have lost resistance to it.

Prof Barclay says flu infections are worse in winter, but the reasons are not clear. It may be because the virus survives best in cold damp air.

Australian flu also leaves the body susceptible to other strains, as well as other infections such as norovirus, the “winter vomiting” stomach bug that causes diarrhoea and projectile vomiting.

Is it too late for me to be vaccinated?

No: the current risk from Australian flu could continue for months. PHE says you will develop antibodies within 10 to 14 days of receiving the jab.

NHS flu vaccinations – designed to protect against Australian flu as well as some other strains – are available to everyone aged over 65, those with a long-term medical condition (such as heart, lung or kidney disease, diabetes or a neurological disease). You should also speak to your GP if you already have a weakened immune system – for example, due to chemotherapy.

Will asking for a vaccination only add pressure to the NHS?

Professor Helen Stokes-Lampard, chairman of the Royal College of GPs, said: “The entire NHS is currently facing intense winter pressures and NHS staff in all areas of the service are working incredibly hard to deliver the best care possible for their patients.

“Although we are reaching peak flu season, we want to reassure patients that the influenza vaccine remains the best protection against flu this winter period.

“It is not too late for patients to receive their vaccination, and we would encourage patients, particularly those in an at-risk group, such as those with long-term conditions and pregnant women, to have a flu jab from their GP practice or pharmacist.”

Do I have to have an injection?

The vaccine comes in two forms; a nasal spray currently being offered to children, which is a weakened but live flu virus that creates a mild infection and can give 100 per cent protection; or a killed virus that stimulates antibody production and is being offered as an injection to elderly and vulnerable people.

It is tailored to specific strains of flu and is based on predictions of which strains are likely to be prevalent. Historically, this has not proved terribly effective or accurate with large numbers of vaccinated people often still developing flu.

According to data from the Organisation for Economic Co-operation and Development, vaccinating over-65s against flu is something we do better at than any other European country.

Despite the fact more than 70 per cent of our elderly population is ostensibly protected, we still have an issue with flu infections. Experts admit the vaccine is only 40-60 per cent effective for reasons that are not clear.

Why are healthcare staff not vaccinated?

Vaccination is currently voluntary for them, and at least 40 per cent don’t bother. Last week, Sir Bruce Keogh, the NHS medical director, said mandatory jabs should be considered to reduce the risk of them infecting patients, but forcing people to be vaccinated could be illegal.

What else can be done to avoid the flu?

Crowded indoor spaces – such as family living rooms, school classrooms and warm offices – are a particular risk. If you travel on public transport, use hand sanitising gel until you can wash your hands properly, in warm, soapy water.

If you must sneeze or cough in public, don’t cover your mouth with a tissue, as virus particles can be transferred on to your hands. Instead, do the “dab”, a dance move created by crooking the elbow across the face. Virologists say sneezing or coughing into the crease of your arm far reduces the likelihood of the contagion from spreading.

Anything else I should be doing to guard against getting it?

There are a myriad of strategies up you can employ to protect yourself against falling prey to the flu. As well as getting the vaccination and and frequently washing your hands, here is what you can do:

  1. Drink less alcohol. Well-known for interfering with sleep quality, booze also affects our immune systems, making it more difficult for our bodies to ward off infection for up to 24 hours.
  2. However, don’t throw out your alcohol – it works well as a disinfectant. If you are running low on anti-bacterial gel but have some vodka handy, some say it does the trick.
  3. Take zinc supplements, lozenges or eat food high in zinc. The mineral keeps the immune system strong, so pile your trolley high with beef, oysters, pumpkin seeds, spinach, kidney beans, lamb, mushrooms, flax seeds, garlic and eggs (for the zinc-packed yolk).
  4. Book a massage. Studies show that those who had a 45 minute massage had a larger amount of lymphocytes – white blood cells that help protect us from disease.
  5. Clean your mobile. You’ve probably heard that there are more germs on your desk than your toilet – but did you know there are also more germs on your phone? Holding a mobile phone against your face while you talk is an easy way to open yourself up to infection, so make sure you clean yours with an anti-bacterial wipe regularly.
  6. Drink more water to flush out toxins through your lymph system.
  7. Carry your own pen. A lot of people touch pens in banks, post offices and GP surgeries; using your own limits the amount of germs you encounter.
  8. Avoid touching handrails on public transport. Already a breeding zone for germs, public transport is made all the more contagious when you start holding on to handrails. Don’t do it – or, if you must, hold onto them through your sleeve.

When should you go to the hospital?

If you develop a sudden chest pain, have difficulty breathing or start coughing up blood, call 999 or go to A&E.

You should contact your GP if your symptoms don’t improve after seven days, you are 65 or over, pregnant, or have a long-term medical condition (such as heart, lung or kidney disease, diabetes or a neurological disease).

You should also speak to your GP if you already have a weakened immune system – for example, due to HIV or chemotherapy.

However, the Northumbria Healthcare NHS Foundation trust is also recommending that no children under the age of 16 come as a visitor to inpatient wards and hospital facilities due to the on-going flu and norovirus outbreaks.

A spokesperson said: “They will not be allowed to visit maternity, pregnancy assessment or the birthing unit under any circumstances. Only immediate family will be permitted to visit the Special Care Baby Unit.

“This is for both their own and our patient’s safety as they are among the most at risk of catching and/ or carrying both flu and norovirus.”

They added: “In areas where visiting is open please remain vigilant: wash your hands thoroughly (soap and water – not alcohol gel).

“Please do not visit if you have symptoms of norovirus or any respiratory or flu-like symptoms; you will only endanger yourself, our staff and your loved ones.”

What about the norovirus?

As well as higher levels of flu, the norovirus is also causing problems for hospitals. Six hospital wards are now on lockdown as outbreaks of norovirus continue to spread across Northumberland and North Tyneside.

The norovirus, which causes diarrhoea and projectile vomiting, is one of the UK’s most common stomach bugs.

It is more prevalent in the winter, with levels of the illness contributing to current NHS pressures.

An NHS spokesperson said: “This isn’t just one large outbreak – as both flu and norovirus are in the community it will continue to be brought into our hospitals.

“Often this is unavoidable – if the patient is frail or very young for instance – as anyone in need of care will always receive it.

“However, wherever possible we are urging residents to either call 111 or talk to a pharmacist rather than risk bringing either bug into the hospital. Both are nasty but with common sense steps – drinking lots of water and staying warm – they can be managed.”

There is no cure for norovirus, meaning the best thing for anyone suffering from norovirus to do is to stay at home and let it run its course.

What are the prospects for a universal vaccine that works against all flu strains?

Good. Researchers have synthesised a natural type of immune cell found in some people. Results from trials involving hundreds of people of a product called Flu-v, which was developed in Britain, are expected by the end of March. It is hoped that the vaccine will offer protection against all strains of flu for many years.

Written by Lois Rogers