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Health experts have warned that the swine flu vaccine could give children a high fever. Officials from the European Medicines Agency warned that children receiving a second jab of the vaccine could see their temperatures spike and that parents should monitor their children carefully.

The warning comes as GPs prepare to give the vaccine to all healthy children under the age of 5. Current plans will see them receive two half-dose vaccines, with three weeks between the first and second injection.

The European Medicines agency said the reaction was ‘unexpected’, as previously it had not been noticed with the trial injections. Previous reported side effects included soreness where the injection was delivered, irritability and drowsiness after the second dose.

They did however conclude that a single vaccination ‘triggered a good immune response’ in children, while two injections offered further protection against the influenza strain.

While it has been suggested that the warnings could prompt the Department of Health to alter the current plans they have in place for delivering the vaccine, the EMEA encouraged doctors to continue with their current program of vaccination, according to the recommendations each country’s government had prepared.

The Department of Health in a statement said that they were encouraged that there was a positive response in children after the delivery of the first half dose, but said that they were seeking advice from the independent Joint Committee on Vaccination and Immunisation as to whether one single half-dose was sufficient as a vaccine for children. They promised that if necessary, new guidelines would be developed.

Think of swine flu and you might think runny nose, cough, the horrors of a temperature. If you’re riddled with flu then social etiquette is probably not too high on your agenda – but for the posh people at Debretts, social etiquette should always be on the agenda.

So to help navigate our tricky Christmas social calendars in the best of health, the social mores rulebook has usefully provided guidelines on how to get through the potential minefield that is mistletoe swine-flu free.

For those planning tongue sandwiches at the office party this year its bad news, as apparently kissing on the lips is off the menu. Equally, there should be no wandering hands and it’s not the done thing to ‘leave a saliva trace’. Nonetheless, Ab-Fab style air kissers should also beware, as the practice is forbidden, along with making loud ‘mwah’ noises to up the authenticity.

The polite way to do it is apparently to briefly touch your cheek to the other person’s. Raunchy. Even if you are repulsed by your kisser, you should still allow them to make their move, but only if neither party are masticating some devils on horseback at the time. Drunks are also advised to avoid the mistletoe as their ‘social skills might be impaired’.

Debrett’s social etiquette advisor Jo Bryant said the cheek-bump was a far more hygienic way of greeting, as it has been medically proven to allow fewer germs to be passed on. Hands contain thousands of germs whereas cheeks are less contaminated.

She added that as people are more aware of the spread of germs this year, there is a set of manners relating to hygiene and health.  Those feeling unwell should stay at home while those instigating the snog should ask first and then avoid overly close contact during the kiss itself.

Hmm. Swine flu is definitely to be avoided, but any sensible person goes to a Christmas party with the clear intention of imparing their social skills and then entwining tongues with some equally inebriated party flotsam under a bit of twig. I would take it as a grave social slight were someone instead to try and bump cheeks with me and would probably storm off in a drunken hissyfit were this to happen.

Is that what you want, Debretts posh people?? A ruined Christmas for the nation? Is it???

The Department of Health today confirmed that healthy children under 5 were to be offered the swine flu vaccine.

The news comes despite an overall fall in the number of swine flu cases being reported weekly, the second fall in two weeks. This week it is estimated that there were only 55,000 cases compared to 64,000 new cases the week before.

However it is thought that the decline could be due to the half-term and unseasonably warm weather. Students have been one of the main sources of transmission of the virus.

The plans to vaccinate under-5s comes as latest governmental bulletins showed that despite the total decline in the number of cases, there has been a marked rise in the number of children being admitted to hospital and patient deaths.

In England last week there were 18 deaths related to swine flu, bringing the total death toll up to 215. England has experienced the largest number of fatalities, at 142, followed by 39 deaths in Scotland, 21 in Wales and 13 in Northern Ireland.

The Department of Health believes that young children are particularly vulnerable to the virus, with about 14% of all the deaths in children under 14.

The vaccination program is targeted at those most at risk, such as those with pre-existing medical conditions, health care professionals and pregnant women. GPs have been warned that as the number of those needing to be vaccinated rises from 14 million to 20 million, they should begin offering the vaccine to healthy children before Christmas, even if the vaccinations for others in priority groups has not been completed.

There has been criticism over Egypt’s handing of a group of tourists who saw their children taken to makeshift hospitals after passport officials suspected them of having swine flu.

Up to 40 children were taken out of the airport and kept in the hospital for days when they were believed to be carrying the influenza strain. Newspaper reports that some children were kept apart from their parents for up to five days.

Parents reported how policemen grabbed their children ‘without warning’, saying that as their temperature was 38C they needed to be taken to hospital. The officials at Sharm El Sheik airport used hidden thermal imaging cameras to scan the children’s body temperature as they came through customs.

Sarah and Chris Kemp said that their passports were taken at gunpoint, and the policemen refused to return the passport of their daughter, Ellie, eight. They complained that the ‘hospital’ that their children were confined to was filthy and filled with mosquitos, while they were forced to sleep on urine-stained mattresses with about 30 other families.

Another family, the Plants, said that they were told they would be arrested if they took their son Zachariah out of the hospital, which they claimed was infected with rats.

While some of the children kept in hospital tested positive for the swine flu strain of influenza , others didn’t, though their parents were afraid they would pick up an infection in the hospital. Those who were treated were prescribed Tamiflu and are recovering well.

The Foreign Office said that there was little they could do about the situation as the ‘measures have been put in place by the Egyptian authorities.”

GPs have warned that rising numbers of people contracting swine flu is coinciding with an increase in people contracting norovirus, the winter vomiting bug, putting strain on family doctors.

Official statistics have shown that norovirus has been steadily increasing over the past few weeks and a bulletin to the NHS has now been issued warning that the increase is the usual indication of an approaching national outbreak.

Callers for the NHS direct service complaining about vomiting have now reached about 4% of all callers, indicating that the virus is now circulating in communities and according to the bulletin, marking the “beginning and continuation of periods of increased norovirus activity.”

The chairwomen of the London-based Local Medical Committees Dr Michelle Drage said that though GPs were used to seeing an increase in cases of norovirus and influenza over winter, when combined with the swine flu vaccination program they were expecting‘pretty hectic time’ over the coming months.

She added that patients with minor cases of flu should stay at home and not visit the doctor unless absolutely necessary. The Health Protection Agency said that as norovirus was highly contagious, good hygiene was essential, including frequent handwashing.

They warned that as there was no specific treatment for norovirus, most people would just need to let the illness run its course, drink lots of fluids and avoid preparing food for at least 48 hours after the symptoms had disappeared.

The animal rights charity Peta have had their latest advertising campaign pulled after complaints were received that it mislead consumers about the link between eating meat and swine flu.

The advertising watchdog the Advertising Standards Agency launched an investigation after the poster campaign was drawn to their attention. It contained large block text saying ‘meat kills’, with smaller text in the background listing a variety of superbugs such as mad cow disease, E-Coli and swine flu, which was more prominent than the other diseases. Beneath this was the tag line, ‘Go Vegetarian. Peta’.

Peta said that the poster was intended to highlight the role livestock played in the incubation, development and spread of infectious diseases rather than imply that meat-eating caused swine flu. They added that it highlighted how reducing meat consumption was one of the best ways to prevent diseases like swine flu developing and spreading.

The ASA found that though the intention was to highlight livestock and meat production, the message that came across was ‘at best, ambiguous.’ In a statement they said that readers might infer from the poster that eating meat caused swine flu, making the poster likely to mislead.

They concluded therefore that it had the potential to cause ‘undue fear and distress’ to some people and ordered the posters be taken down.

The Chief Medical Officer for England has said that a ‘lucky break’ has slowed down the spread of swine flu, allowing health officials more time to roll out the vaccination program.

Sir Liam Donaldson said that so far the epidemic is proving to be a ‘slow burner’ and suggested that it was possible that the virus might peak at a lower level than previously predicted, as well as peaking earlier.

In a press conference, he said that the slow escalation of the influenza virus would allow doctors to get the vaccination program well under way before too many people fell ill and was hopeful that if there was the possibility that the flu might peak again, as happened in the pandemic of 1968, this might be avoided completely.

Though experts had been expecting the rates of infection to double week by week as the second wave got under way, so far the rate of increase has been well below this, with 18,000 new cases of the virus reported, compared to 14,000 the previous week.

It has been suggested that the slower-than-expected infection rate could be due to over 65s previously having been exposed to a similar influenza strain in the 1950s, as well as immunity having developed amongst those who were exposed over the summer, particularly children of school age.

GlaxoSmithKline have announced that they have received 22 new orders from the government for their version of the swine flu vaccine, called Pandemix. The order is equivalent to 149 more doses of the drug.

It is expected that the first supplies of the vaccine will be shipped this week and there will be two shipments, in the fourth quarter of 2009 and at the start of 2010. The British pharmaceutical firm have said that each dose of the vaccine will be sold for the same price as its seasonal flu jabs, at around £5. This means that with total orders for the vaccine currently at 440 million, the firm are in line to make profits of about £2.2 billion.

The company has also made agreements with the U.S government to provide them with additional products to combat the pandemic and is still in discussions with other governments worldwide who are interested in purchasing the vaccine to protect the population.

The swine flu vaccination program is almost ready to start nationwide as the first children in Britain received their immunisations against the virus. Medics at 5 different sites in England are currently comparing vaccines from two different manufacturers in order to see which has fewer side effects and is most effective.

One of the vaccinations, GlaxoSmithKline’s Pandremix, has already received approval from the European regulators . The second, made by Baxter, is expected to be approved this week once the European Medicines Agency has finished considering it.

The government plans to recruit 1000 children over the next two weeks from the Oxford, Bristol, Southhampton, Exeter and London regions. They are seeking children aged between 6 months and 12 years.

Once the clinical trial is completed, there are plans for 11 million people considered most at risk from the swine flu virus to be offered the vaccination, and it will also be made available to over 2 million front-line health workers.

The head researcher on the trial, Professor Andrew Pollard of Oxford University, has described the trials as a ‘race against time’, as the flu season has already begun. Over the last week reported cases of the virus have doubled, an indication that the expected autumnal ‘second wave’ is already underway.

The estimate for the number of swine flu deaths that Britain can expect should be reduced by 2/3s, it was claimed by the government’s Chief Medical Officer Sir Liam Donaldson.

While the figure given in July was 65,000, this was reduced to an estimate of 19,000. Sir Liam said the revision in the estimate was calculated by government scientists, who base their predictions on the estimate that 1 in 3 people would catch swine flu.

However original estimates did not take into account the swine flu vaccination, which has lead to the lowering of the expected mortality rate. Sir Liam also predicted that Britain could expect the predicted second wave of the virus in about 7 weeks.

Recently the rates of infection have been steadily dropping, with a drop of 5,000 in diagnoses in the past week. There has also been a 26% drop in people consulting their GPs about flu-like symptoms. The current death toll in the UK from swine flu stands at 70.

Though the news is encouraging, businesses have been warned not to underestimate the pressure workers' illness could put on them. After a survey from the British Chambers of Commerce showed that many companies did not have contingency plans if there was a high level of worker absence, the Chartered Institute of Personnel and Development (CIPD) and the Business Continuity Institute (BCI) issued joint guidelines on how firms should prepare for workforce illness.

As the revised estimates were announced, new results from the trials into the swine flu vaccine indicated that the vaccine would work better if delivered in one dose, rather than two as the researchers originally thought.

Two of the swine flu centres opened to cope with the pandemic are to close this week after demand for the service fell. The Department of Health say that the decision was made after infection rates fell back quickly.

The two centres scheduled to close are in Watford and Farnborough.

1,200 posts will go but the spokesperson from the Department of Health said that as the service was flexible it could be scaled back up if infection rates rose. They have warned that they expect a second wave of infection in Autumn as the schools start their new term and in Winter, the traditional flu season.

The swine flu centres opened to take the strain of GPs and NHS staff when they were swamped with cases and patients afraid that they might have contracted the strain of Influenza. The staff in the centres, some of which remain open, are able to authorise prescriptions of the anti-viral Tamiflu, which designated ‘flu friends’ can pick up for the patient.

The service is run by NHS Professionals and a private company, Teleperformance. NHS Professionals said the move was due to “much lower than expected call volumes”.

This week the WHO gave the advice that healthy patients whose illness was uncomplicated did not need to be prescribed anti-viral drugs like Tamiflu. There has been growing controversy about the prescription of Tamiflu in the UK, especially regarding its being given to children.

Doctors have been warned to look out for the rare disease Guillain-Barre syndrome in patients as the swine flu vaccination program gets up and running. Neurologists are afraid that incidents of the illness will increase during the pandemic and as people are vaccinated.

Little is known about the syndrome but it is believed to be caused by an auto-immune reaction. It can cause temporary paralysis and affects the nervous system. Doctors have already pointed out that a US vaccination program in the 1970s lead to a big rise in the number of cases.

From October, over 13 million people are set to be given the vaccine against swine flu, including those with asthma, renal failure or other underlying health problems.

A Health Protection Agency spokesperson said that as the vaccine was given out, there would be enhanced surveillance for Guillain Barre, but added that this was normal procedure whenever a new vaccine was introduced.

The head of immunisation at the Health Protection Agency, Elizabeth Miller, also wrote a letter to the Association of British Neurologists saying that GBS had been identified as condition that doctors would need to keep an eye out for when the vaccine was rolled out.

Trials have begun in Leicester of the first swine flu vaccine. Some 175 people have enrolled in the program, which will be taking place at the Leicester Royal Infirmary.

The volunteers will receive two shots of the vaccine, and their blood will then be tested to see their levels of immunity. The trial is also designed to discover the best time gap to leave before giving patients the first and second dose of vaccine.

Last night the upcoming World Cup match between Wales and Russia became a little bit dirtier after Russian health chiefs offended the Welsh with warnings to fans not to travel to Cardiff  - to avoid catching swine flu.

The head of Russia’s state health agency even suggested that the match, scheduled for September 9^th, be cancelled, describing the game as “extremely unnecessary and inappropriate.” Gennady Onishchenko is so alarmed by the prospect of a truckload of swiney fans returning back to the motherland that he vowed to “persuade our compatriots not to go to this match in Britain.”

So far Russia has only reported 55 cases of swine flu. Britain by contrast has hit the 11,000 mark, though only 30 people have died. However Onishchenko, who may well have a glittering future as a diplomat ahead of him, implied that we possibly were concealing the true extent of the outbreak, warning, “Our sources indicate that these figures are inaccurate” and postulating that the real number of those infected was tens or hundreds of times higher.

The Football Association of Wales have insisted that they have had no indication from their Russian colleagues that the match may be cancelled and expressed the hope that fans would be not put off coming.

They then added that they believed the advice was a case of someone trying to make a name for themselves and promised to welcome the Russians with “open arms”.

Smooth-tongued Mr. Onishchenko concluded rather alarmingly that the Russians “will be dissuading... countrymen” who express “willingness” to travel, conjuring up vivid images of thumbscrews and football fans rotting in cells, brokenly muttering, “I just vanted to see zee footie...”

A British schoolgirl is fighting for her life after being admitted to hospital in Greece with complications caused by swine flu. Natasha Newman, 16, is being treated in the intensive care unit of Penteli Children’s Hospital in Athens and is described as being in a “very serious” condition.

Natasha was on holiday on the island of Cephalonia when her illness started to give concern. It is believed she first contracted the flu in the UK but did not seek medical attention until her symptoms became critical, trying first to just carry on with her holiday. The schoolgirl had just finished her GCSEs at the prestigious Scottish boarding school Gordonstoun.

Greek doctors have said that she is receiving Tamiflu and antibiotics, as well as other treatments. She is believed to have contracted the virus ten days ago but did not seek medical help until the 8th day. She was airlifted from Cephalonia on Monday with a dangerously high temperature.

Meanwhile, Sir Liam Donaldson, the chief medical officer, has said that he is hopeful that the rate of infection has reached a “plateau”. He said that the number of new cases is no longer rising as rapidly and there has also been a fall in the number of 5 -14 year old children contracting swine flu, believed to be due to the start of the school holidays.

However there has been a rise in the number of cases reported amongst other age groups and in the North of England. Health experts believe that the full extent of the infection will not be felt until Autumn, when schools start again and workers return from the holidays.

A House of Lords report to be released tomorrow is widely expected to criticise the government for being slow in setting up the swine flu helpline that was eventually launched on Thursday. The Lords report attacks ministers for not following the set timetable for setting up the phone line, after a variety of newspaper reports suggested that the delay was caused in ministerial and inter-departmental infighting.

The Science and Technology paper will say that ministers failed to still to the timetable they set fir themselves for informing and advising the public. In 2005 the committee recommended that te government needed to make it a priority to ensure that they prioritised access to information uin the event of a pandemic.

The Hotline was launched so patients can get advice, diagnosis and treatment without going to their GP’s surgery. Within an hour of the website going online, it was receiving 2.600 hits per second. The website has proved more popular than the phoneline, with 80% of the 58,000 assessment completed in first day being done online.

When patients are diagnosed with the virus, they are given a unique reference code that their ‘flu buddy’ can use to go and pick up a prescription from the dispatch centre.

Ministers have hit back at claims that they took too long to get the information services up and running, with Gillian Merron, health minister, saying that the service could only be launched when the infection had moved past local outbreaks to significant levels of infection across the country.

Fears have been raised that the fast-tracking by the government of the new swine flu vaccine may be dangerous and inadvisable. Experts, including Dr. Richard Halverson writing in The Times , have questioned whether pushing the vaccine out without full tests on humans might put people’s health at greater risk than that posed by the swine flu virus itself.

Dr. Halverson drew parallels between current plans and the American swine flu vaccination program of 1976, when a vaccine was offered to the entire population to stop an epidemic. Millions accepted, but after people developed Guillain-Barre syndrome (a type of paralysis, which is usually temporary) the program was halted. One case of Guillain-Barre was reported for every 100,000 vaccinations.

In the article, the doctor, who works as a London GP and directs the children’s immunisation program BabyJabs, warned that rushing the vaccine onto the market would mean we would have no idea how effective it was and said that judging by other flu vaccines there was no good evidence it would help children with asthma, pregnant women or offer more than “moderate” benefit to the elderly.

He theorised that by the time the vaccine was ready to be rolled out to the wider population, possibly most people would have come into contact with the virus and would have developed some degree of immunity.

He described vaccinating people with a medicine that had not gone through the proper safety test, especially as these would be done on healthy people rather than the vulnerable and most in need of it, as a “massive gamble”.

Professor Sir Gordon Duff of the Scientific Advisory Group said that much consideration had been given to the risks of offering the vaccine but that they had decided that the benefits outweighed the risks of “letting the flu run away with itself.”

It’s a difficult call to make. Personally, I think I would rather put up with a bout of flu than take a medication that had not properly tested. That said, I am not in one of the at-risk groups.

The government is trying so hard to reassure the population that they are in control that it is to be hoped that they haven’t let the desire to seem uber-decisive and on top of the situation push them into the decision to vaccinate, even though it may be extremely risky.

After prospective mothers were issued with alarming advice to consider putting off getting pregnant until the swine flu pandemic has passed, Andy Burnham, the health secretary, today urged the British public to have confidence in how the NHS was handling the crisis.

The weekend saw a spate of worrying headlines hit the newspapers, from conflicting advice about what pregnant women should do to protect themselves to criticism of the handling of the pandemic hotline.

The NHS Website had advised pregnant women to reduce their chances of getting infected by avoiding public transport and crowded spaces. The Royal College of Midwives went further and suggested expectant mothers might want to leave earlier or later to avoid rush hour tubes. It is believed pregnant women are particularly at risk from swine flu, as their immune systems work less well to prevent the baby being rejected.

However the website was then changed on Sunday and later the department of heath released a statement saying that they “might consider” avoiding crowds but that it was important to carry on with their routine.

The National Childbirth Trust advised women to consider postponing pregnancy, but the chairman of the Royal College of GPs dismissed the advice as ‘scaremongering.”

Meanwhile, the Observer newspaper carried a story claiming that the national pandemic hotline, providing advice to patients and helping distribute anti-viral drugs, was severely delayed by infighting between different Whitehall departments.

Andy Burnham went on to GMTV (he seems to like it there – he’s made a couple of “don’t panic” type statements from the comfort of their squishy sofas) to deny that there had been any conflicting advice issued.

He said that Britain had the best preparations in place to cope with the pandemic and was dealing with it “fantastically well.” There have, however, been reports of chaos at the first distribution centre for anti-virals in London and we have noticed a deluge of new enquiries from members of the public who do not trust the Government's system of distribution to get Tamiflu to them in time.  There has also been concern that the new Swine Flu hotline will be staffed by people without any medical training.

Government officials are attempting to calm fears in Britain after a previously healthy 6 year old girl died suddenly after contracting swine flu. Chloe Buckley from London died soon after being taken to hospital, though it has not been confirmed whether the cause of death was swine flu or whether the patient had any underlying health problems. Earlier reports that a family GP from Bedfordshire died from swine flu were not correct: he died of natural causes.

Doctors have been criticised for not immediately prescribing the child Tamiflu. Initially, she was diagnosed as having tonsillitis and sent home, but her condition rapidly worsened. Her parents have issued a statement stating that they are happy with the care that she was given and reports in the press were not correct.

Research coming from America and Japan has suggested that the strain of influenza can cause considerably more damage to the lungs than ordinary seasonal flu, while a study just published in the journal Nature has indicated that swine flu should be treated as being more severe than the seasonal kind.

Andy Burnham, the Health Secretary, has asked parents not to panic. Speaking on GMTV, Mr. Burnham pointed out that many children had only experienced mild symptoms and had recovered well from the virus and said that people needed to keep the recent deaths in “perspective”.

A vaccine for the virus is currently being developed and is expected to arrive at the end of August. It is thought that the full vaccination program will be rolled at the start of September. The government says that it has ordered enough vaccine for the whole of the British population and it is likely that the most vulnerable - those with underlying health problems and the elderly - will be immunised first. People may need two separate vaccinations to ensure immunity.

A memo leaked to The Times has revealed that senior healthcare officials are concerned that the NHS is not well enough prepared to deal with the expected swine flu explosion over the next few months.

In correspondence between the officials, they seemed to express views that plans to hand out medication and relieve the strain on GP and hospital services are a “complete waste” of time. A memo leaked from the health service indicated that current emergency plans are contradictory and confused.

The memo accused the government of “muddled” thought processes. Its author suggested that the creation of Tamiflu vouchers, where someone diagnosed over the phone with swine flu can send a representative to pick up their prescription, could actually hamper efforts to distribute medication. He argued that existing prescription forms would work just as well.

Sir Liam Donaldson, the chief medical officer, has admitted that they can not be sure of how many people in the UK have contracted swine flu as many people, as the symptoms are mild, will have chosen to stay at home and not contract their doctor.

The chief medical officer for the government, Sir Liam Donaldson, has warned the public not to panic-buy anti-viral drugs to treat swine flu on the internet. As well as reminding the population that the NHS has stockpiled large amounts of the drug Tamiflu, he warned that many companies were selling counterfeit versions of the medication.

The instructions come as the government admitted that the virus was no longer containable. It is now expected that within a month as many as 100,000 new cases could be diagnosed each day. Andy Burnham, the health secretary, said the NHS had now moved to ‘treatment phase’ in dealing with the pandemic. This means that schools will no longer close as a matter of course when a case is diagnosed and anti-viral medications will not routinely be given as a preventative measure when someone comes into contact with the virus.

Some experts have predicted that this will lead people to seek the medication from online pharmacies. The Royal Pharmaceutical Society’s Director of Policy David Pruce warned that internet sites could be based anywhere in the world and added that counterfeiters had become so good at copying the medication it was impossible to tell the fakes from the real thing.

As a guideline, Tamiflu and Relenza are both prescription-only medications. You should only be able to buy the drugs with a prescription, and if online clinics claim that they can provide you with this, check the registration details of the prescribing doctor. Then check that the pharmacy is registered with the Royal Pharmaceutical Society.

We have not received confirmation that the World Health Organization has raised its flu virus alert level to Level 6.  This indicates that we have a flu pandemic for the first time in 41 years. As we said earlier, the raised alert level is not connect to the virulence of the virus; it simply relates to how fast it is spreading from human to human.

There have been around 27,000 reported cases in 74 countries although the actual incidence of infections will be much higher as not all cases are reported.  So far there have been 141 deaths related to the swine flu virus. There have been 822 cases in the UK but no fatalities. The virus appears to cause symptoms that are relatively mild in nature although this may change as the virus develops.  A few cases have resulted in complications. The Chief Medical Officer has said that there should be no cause for alarm and he has stated that the Government has a plan in place in the event of a large outbreak of the virus in the community.

We have heard that the World Health Organisation is meeting in Geneva today to discuss raising the alert of Swine Flu from Level 5 to Level 6. A Level 6 alert means that the speard of the swine flu virus has reached pandemic levels. This should not be interpreted as meaning that the severity of the virus has increased, it merely relates to the spread of the infection.

We have seen a number of people approach us today for a prescription for Tamiflu and Relenza.  We have Tamiflu in stock but we are still out of Relenza unfortunately.

People should not panic if the WHO raises the alert level as the Government has made substantial provisions to deal with any threat from the swine flu virus.

A leading flu expert has warned that it is very likely Britain will be hit by a swine flu pandemic as autumn arrives. An expert of virology, Professor John Oxford from the Queen Mary School of Medicine has said that the re-opening of schools and universities after the summer break and the return of workers from their summer holidays will create the ideal environment for swine flu to spread.

He has suggested that there may already be cases in the UK that have gone undetected, pointing to sporadic cases that have appeared without links to people who have been travelling. He believes this shows the flu is ‘silently’ spreading. So far, there are 244 confirmed cases in the UK. Ireland has recently announced their second patient, a school boy believed to be a pupil at Eton College, where there has been an outbreak.

Scientists will be keenly studying the spread of the flu virus in the Southern Hemisphere, where countries such as Australia and South Africa have already entered their winter season, traditionally the peak flu season. The spread of the virus there will give a good indication of what the UK may expect when summer ends.

Professor Oxford said that it was crucial that if a pandemic does arrive in the UK, then people continue as far as possible to continue with their normal routines. He warned that otherwise, an economic crisis could be the result, but with social distancing and some protective measures, such as shielding the mouth with the crook of the arm when coughing, there would be no need for people to avoid work or school.

Though reassuring reports have been coming in from health agencies about the dangers posed by swine flu, the government today launched a campaign nationwide to deliver leaflets informing the public about how to protect against the virus.

Leaflets are to be delivered highlighting the importance of good hygiene in preventing the further spread of the infection. The leaflets will go to all UK households. The campaign comes as 27 cases of swine flu were confirmed in the UK, including cases at two prestigious London schools, Alleyn’s in Dulwich and South Hampstead High School in Hampstead. Both schools have closed, with three other schools also shutting temporarily, another in London, one in Devon and one in Gloucestershire. Pupils as well as staff have been offered the anti-viral medication Tamiflu as a preventative measure.

So far all the patients with the illness have only reported fairly mild symptoms and all are said to have made, or to be making, a good recovery. The mother of one victim at Alleyne’s, Felicity de Salis, said that despite a high temperature, the virus left her daughter merely “under the weather”. She also praised how the school and authorities handled the situation.

However chief medical officer Sir Liam Donaldson said that is was very possible that there would be a second, larger wave of infection during the traditional flu season of autumn and winter. The World Health Organisation has said that they will still be on high alert. A spokesman said that as Spanish flu of 1918 surged in spring but then returned strongly in autumn, they were remaining on their guard.

Good news came from Mexico where shops, schools and businesses are preparing to reopen on Wednesday. Senior health officials in both Mexico and the U.S have said that they believe the rate of infection has peaked.

The World Health Organisation has just raised the alert level to 5 - only one away from pandemic level. We will keep you posted once we hear any further information.

We are now expecting some supplies of Tamiflu tomorrow morning and we will keep everyone updated.

5 cases of swine flu have now been confirmed in Britain, among them a 12-year-old girl, Gordon Brown today confirmed during a session to the Commons during Prime Minister’s Question Time. Cases have now been diagnosed in Devon, London and Birmingham, as well as in Scotland, the first region to report infection.

The Prime Minister said that all preparations necessary to avoid the infection spreading were being taken. These are believed to include the emergency purchase of face masks for medical personnel (though their efficacy is being disputed), the expansion of stocks of anti-viral drugs from 35 million doses to 50 million, and the printing of an information leaflet that will be distributed to every family. The leaflet will have basic tips on how to safeguard health, such as is given out during winter flu season, such as instructions to cover your mouth after sneezing, dispose of tissues quickly and wash hands regularly.

In the U.S the only fatality outside of Mexico has been announced, after a 23-month old baby died in Texas. The World Health Organisation is meeting in Geneva to discuss the alert levels that they have in place; currently they are at level 4, with level six indicating that swine flu is considered a pandemic.

Across Britain, pharmacies have been reporting a run on stocks of Tamiflu and Relenza, the anti-viral drugs believed to treat swine flu. Most are totally out of stock and manafacturers Roche (Tamiflu) and GlaxoSmithKline (Relenza) have said that until the government changes current regulations restricting the release of the medications into the pharmaceutical network no new stock will be released to the public.

The first case of swine flu was confirmed in the U.K today as the World Health Organisation upped its alert system to a 4 out of a possible 6: 6 meaning that a pandemic has been confirmed. Scottish newlyweds Iain and Dawn Askham , who had been in Mexico for their honeymoon, are reported to be recovering well in hospital and their friends and family are being monitored for the signs of the virus.

As it becomes more and more likely that we are going to see further U.K cases, however, experts are indicating that this strain of influenza is not as serious as others, such as avian flu. Part of the H1N1 strain, we already have some degree of immunity towards it. Others have also pointed out that the U.K, heading into summer, is in a better position than Latin America and other countries in the Southern Hemisphere, as they are moving into winter, naturally the season where influenza takes stronger hold. Alan Johnson, the health secretary, has said that the U.K is almost uniquely well-placed to deal with a pandemic and after 5 years of planning for this eventuality has stockpiled enough anti-viral medication to treat at least half the British population.

The European Union has announced that henceforth ‘swine flu’ will be known as ‘novel flu’ to avoid any damage being caused to the pig and pork industry.  Though the influenza is a cross between a strain found in humans and a strain found in pigs, it is not believed to be passed on through contact with pigs or pig products, but via human-to-human contact.

World Health organisations are moving into place to contain an outbreak of a potentially fatal strain of influenza, swine flu. Believed to have originated in Mexico, so far 103 people have died there, though there have been no reported fatalities in any other countries.

A breakthrough by scientists in the U.S has offered hope that a vaccine protecting against all strains of flu is now a possibility within two years. At the moment, vaccines against even seasonal flu have proved hard to develop as the virus is constantly mutating, requiring new jabs every winter. The new research has discovered antibodies which target the vulnerable point in the virus, stopping the crucial mutation that allows the virus to infect cells.

At the moment, flu jabs are only able to target proteins on the surface of the virus, which means the cells can continue to mutate. The new vaccine could protect not only against the winter flu virus, but the virulent H5N1 strain of bird flu. Doctors are concerned that at the moment, were a pandemic to break out many would die before a vaccine became available.

However it is hoped that by offering a treatment based on the research, large amounts of a single-dose treatment could be produced which would contain whatever virus it was for 4 to 6 months, allowing time for a suitable, targeted vaccine to be created. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases which funded the research, said that the findings published in the journal Nature Structural and Molecular Biology held “considerable promise for further development into a medical tool to treat and prevent seasonal as well as pandemic influenza.”

This month the government announced that it was going to double the amount of anti-viral drugs stockpiled for use in the event of a pandemic. This will leave Britain with enough medication to protect about half the population. Pandemics cannot be predicted but generally occur every few decades as the flu mutates. Annually flu kills 250,000 worldwide.

Professor Peter Openshaw however warned that it was probably not “realistic” to consider manufacturing the antibodies as a treatment as the costs would be prohibitive. Nonetheless, he believes that now it has been shown that antibodies that fight such a broad spectrum of different flu strains can be created, “a vaccine...that would make this sort of antibody, and work from one year to the next against as-yet undiscovered types of flu” is on the horizon.

Thanks to years of ad campaigns warning of the dangers of drink-driving, none of us are ignorant about the risks of getting behind the wheel after even one or two drinks. However, research just published seems to indicate that driving while suffering from cold or flu can be almost as dangerous. The symptoms produced, such as stuffy head, wooziness and sneezing can cause a driver’s ability to be impaired to the same extent as those who have drunk enough to bring them close to or at the drink-driving level.

Lloyds TSB Insurers commissioned the research to see how drivers suffering from a range of illnesses and conditions performed. They found that flu or cold sufferers performed 11% worse than healthy drivers, the same performance as those who have downed a double whisky before getting into the car. Slowed reaction times would add 1 metre when driving at 30mph to a healthy driver’s stopping distance of 12 metres .Naturally enough, most drivers are unaware that driving when sick may be dangerous, with 38% of those surveyed saying they had driven when suffering from flu. The company have estimated that considering a YouGov poll where 22 drivers said they had crashed when driving ill, some 125,000 accidents could be caused each year by flu or cold-ridden motorists.

The insurers have warned that driving when unwell, especially if you are taking medication or are fatigued, could put you at significant risk. A spokesperson for them said, “Getting behind the wheel when ill causes thousands of accidents every year. Try to avoid driving if you’re suffering from cold or flu.”

The Royal Society for the Prevention of Accidents have recommended - unsurprisingly - that motorists use their judgement when weighing up whether they are in a fit condition to drive. “A common sense approach is needed as it is possible to drive safely when feeling 'slightly under the weather', but a point may be reached when it is unwise to drive. People need to be honest with themselves about their ability to drive safely."

Studies like this are always interesting, but what impact it will really have on motorists is questionable. Someone with flu would clearly rather be in bed than driving around, so the likelihood is that they are making what they consider to be a necessary journey. No one wants to drive when sick, so unless legislation was put in place, being aware it is a little risky is unlikely to put people off. And were there to be legislation, imagine how that would work. Perhaps points would be deducted according to redness of nose or the number of used tissues on the passenger seat

The NHS is bracing itself today as it emerged that the current flu epidemic, which is already set to be the worst Britain has experienced in eight years, is set to get worse as a deadly Australian strain of the virus spreads.

The European Influenza Surveillance Scheme has published a report warning that flu is going to reach epidemic levels across Europe over the coming weeks. They have drawn attention to the fact that the most common strain in circulation is Brisburn 10, which in 2007 killed 6 children and caused a three-fold rise in flu cases in Australia.

The situation is being worsened because we are reaching the traditional 'peak' flu season, the months between January and March. However, already the UK Health Protection Agency and the Royal College of GPs have noted a sharp increase in the number of cases with flu-like symptoms. The rise in flu cases has co-incided with outbreaks of the winter vomiting bug Norovirus, putting health services under even greater strain.

We have not yet reached epidemic proportions, classified as when the rate of cases exceeds 200 amongst every 100,000 consultations. The rate is currently at about 68 cases per 100,000 consultations.  Doctors are encouraging those groups at risk to have the flu vaccine, which provides protection against the strains in circulation and are authorised to prescribe anti-virals, which combat the flu symptoms. 

A Department of Health spokesperson has recommended the flu vaccine as the best protection against the illness. "The best protection against flu is to have the flu jab...its not too late." They added, "There are simple steps that everyone can take to help prevent catching colds and flu. Always use a tissue to catch your sneezes, throw away use tissues...and regularly wash your hands."

And if you were unlucky enough to catch it - drink lots of fluid, take medicines like paracetamol or aspirin and then retire to the sofa to watch Christmas telly, moan a lot and make your family run around after you.

Perhaps the greatest misery of cold and flu season is the ability of the virus to attack just when it is least wanted. Its almost impressive - big date, loads of work on, family coming over and expecting to be fed? What could make such occasions better than a nose redder than Rudolf’s, a soaring temperature and skin the colour of mouldy yoghurt?

Being fairly irreligious, Christmas for me is one big exercise in vanity, as the prospect of meeting up with long-lost friends at a succession of parties sees me determined to stun them with my bouncy hair, glowing skin and killer heels. I plan this somewhat like a military campaign and have no doubt that my biggest enemy is that mild-mannered business man sneezing into my ear on the tube. I have developed a fine line in filthy, accusatory looks and have taken to trailing scarves in my wake whenever on public transport, as they are amazingly handy for use as impromptu face-shields. Granted, I look a little odd, but it will be worth it when I get through flu-free. I hope.

Turns out, my paranoia is justified. It has now been shown that Brits over their lifetime will spend an impressive three years and fifteen days reaching for the Beechams. Over one year, we will suffer from three colds, each lasting five days, and one bout of influenza. All told, that makes three weeks every year feeling rough. Its also bad for the economy, as 44% percent of us take time off work with a cold and 71% will stay home with flu. The research, done by antiseptic-spray manafacturers Dettol, unfortunately also showed that while the majority of workers feel resentful when their colleagues take time of work with a cold, they also get annoyed by their constant sniffling when they do come in.

For those of you who also intend only to be feeling sick as a result of too much champagne and mince pies, the best way to stay flu-free is to be manic about washing your hands and wipe the surfaces in your home and work down as much as possible. Treat everyone with beady-eyed suspicion, as the flu virus is contagious a day before symptoms start to appear. Finally, don’t be embarrassed to hide the entire lower part of your face with whatever materials are handy - scarves, jumpers, balaclavas…And remember, if people give you funny looks they are doubtless just jealous that you are both warm and have an attractive, personalised version of the white doctor’s mask.

Google is for many people an invaluable tool for gathering information. With millions upon millions of people searching for all manner of things every day, it is one of the most popular websites in the world. In 2006, its total entrenchment in our society was confirmed when ‘to google’, meaning ‘to use the Google search engine to gain information on the internet’ was added to the Oxford English Dictionary.

A few weeks ago we reported on The Online Clinic news blog the startling report published by a Parliamentary special committee. In the report it was stated that avian flu would cause more deaths and devastation in the United Kingdom than any possible terrorist threat. Was this an over-reaction on their part you might ask? Well no, not if you take a look at the figures for previous pandemics. The Spanish Flu pandemic of 1918-1919 killed 25 million people across the globe before it disappeared.

We recently reported in The Online Clinic blog the findings of a Government report into the potential devastation that would be caused by flu pandemic. It was estimated that, in this country alone, 750,000 people would die as a result of the pandemic, and that more than six million children would be affected, including 750,000 children under the age of five.

A few weeks ago we covered a story in The Online Clinic health blog that a parliamentary committee had reported that the predicted flu pandemic would cause more devastation than a terrorist attack. The committee also stated that we, as a nation, are more prepared for a terrorist attack than for the devastation, which will be caused when avian flu finally infects humans.

Ask the average person in the United Kingdom what is the one thing that poses the greatest threat to this country and you would probably not be surprised if they said terrorism. After all, it is a threat that is real, as we have seen in the July 7^th bombings in London. Anyone is able to visit the MI5 website and look at the terrorist threat level in this country. At present it is listed as ‘severe’.

The official list of threats and risks which face this country has, however, until now been kept confidential. On Friday the information was released. It was not shown as a numeric list, however, but as a graph with two lines. One shows the ‘relative impact’ of each threat and the other shows the ‘relative likelihood’. In terms of immediate likely occurrence, terrorism is highest on the graph in terms of likelihood. In terms of potential impact, however, it is flu pandemic which tops the graph.

In a previous article published on The Online Clinic blog we reported the findings of a government committee regarding the potential flu pandemic that stated that it was not a question of ‘if’ but ‘when’. The report said that the number of deaths from the pandemic would be between 50,000 and 750,000 in this country alone and that more than one million people would require hospital care.

It is not possible to predict exactly when the pandemic might occur but experts say that when it does it will come in several waves of between three and six months over the course of two years. The Ministry of Defence has said that the flu pandemic will generate “unprecedented levels of public fear, stress and panic.”

3.3 million doses of vaccine for the H5N1 strain of avian flu have been purchased for the NHS, but it will be impossible to create a vaccine for the pandemic until it actually hits. The virus will need to be identified and a vaccine will then take between four to six months to manufacture, by which point there will have already been a massive loss of life. So although terrorism might have a higher media profile than the predicted pandemic, its effects will be in no way as far reaching as a human flu pandemic.

A year ago it seemed that you could not switch on a television set without seeing a report suggesting that the world was about to be hit by a bird flu pandemic. Gradually the coverage of this issue seems to have faded with climate change again coming to the fore as the main global concern for the human race. Only this week Channel 4 has been hauled over the coals by OFCOM for its documentary The Great Global Warming Swindle in which they misrepresented various facts and scientific opinions to debunk the ‘theory’ of Global Warming. One might think then the threat of a pandemic had passed, as little mention has been made of it for a number of months, this, however, is far from the truth.

Just when it seemed that the panic over a flu pandemic had subsided, startling news has been announced this week which makes this threat a potent reality: that bird flu, which is rife in the Far East, can be transmitted from one human being to another.

This disturbing development in events has come to the attention of doctors in the case of a 24-year-old man who, having contracted the disease from a poultry market, passed on the disease to his 52-year-old father. The young man died as a result of the disease while his father survived. The fact that the H5N1 strain of bird flu has evolved, and now seems to be able to freely pass between humans could be the birth of a strain of the virus which could infect hundreds of millions of people.

The 24-year-old developed flu symptoms after visiting a poultry market in the Jiangsu Province in China. He suffered fever, chills, a headache, a sore throat and a cough. He was treated with antibiotics but with no success. He died in hospital, five days after he was admitted. His father who, importantly, lived six miles away and never visited the poultry market where his son was infected, fell ill a week after going to visit his son in hospital. He himself had to be admitted and spent over three weeks being treated. He was treated with antivirals and the blood plasma from a woman who had been infected with the same strain of avian flu. He narrowly pulled through.

There is a possibility that the father contracted the disease from another market where it was noted that poultry were being slaughtered. The man maintains, however, that he went nowhere near these birds, which strongly suggests that he caught the avian flu from his son. It is thought that this family may have had a genetic susceptibility to the disease though Wendy Barkley, from Imperial College, London, said that there was no firm evidence to suggest that the H5N1 strain has mutated to allow it to pass from one human being to another.

If someone goes to the trouble of getting themselves a flu jab they might, unsurprisingly, assume that their efforts would be rewarded by them escaping full blown flu. Well, apparently they would be under a misapprehension because the latest flu jab, according to the American Center for Disease Control and Prevention offers absolutely no protection against 60% of the flu viruses that are currently infecting people in the USA. A rather startling figure suggests that flu jabs are becoming increasingly insignificant. In typical years a flu jab will protect against between 70%-90% of viruses…this year it is only 40%.

The main reason for this alarming figure is a ‘surprise’ strain which, as well as not being catered for in the flu immunizations is also resistant to vaccines. This strain has been thriving and is responsible for the majority of the USA's lab-confirmed influenza cases.

Dr. Joe Bresee, Head of Influenza Epidemiology, CDC, said that every area of the United States is currently experiencing major outbreaks of flu, but that it was too early to know whether this year will go down in the records as one of the worst outbreaks. Last week 31 states in had reported widespread flu activity, this week the number of States has risen significantly, to 44. Since September 10 children have died as a result of the flu virus though scientists have urged that this is an average figure for this time of year.

Scientists are shocked at how badly the flu vaccines have performed this year. Usually predictions on what type of influenza virus strains will be prevalent pretty much hit the mark, and the vaccines, when successful, do offer significant protection. In 16 of the last 19 flu seasons the flu vaccines have performed well, and as expected. The World Health Organization says that the flu jabs given this year should be completely different from the season that has just gone and that the problems encountered this year should be met with a complete overhaul of the flu vaccination process.

We have been bringing you news relating to progress on vaccines that might prevent the spread of a human form of H5N1 in the event of a global flu pandemic.  All of the vaccines that have been discussed to date are traditional vaccines that require to be refrigerated throughout their journey from the clinical manufacturing site to the delivery (usually by way of a needle) to the patient.  We now have news in that a novel way of delivering a vaccine through a nasal powder has just passed its initial toxicology study.  This means that the FDA will now permit the technique to be progressed to Phase I human trials this year.

The new technology is called GelVac and it is owned by a subsidiary of Carrington Laboratories. A Phase I human safety evaluation has already taken place using this technology but without the antigens.  This study showed that the technology was generally well tolerated and safe.

The nasal cavity is widely recognised as one of the best sites for delivering immunisation as most infectious diseases enter the body via this route.  This means that rather than just a normal systemic response that you would expect following immunisation, you may also get a mucosal response at the likely entry point of any infection.

This method of delivery has several advantages over the traditional type of vaccine.  GleVac is stable at room temperature and this therefore disposes of the normal requirement for cold chain distribution which can be problematic.  This means that the vaccine can be sent directly to patients who, because of the easy to use delivery system, can actually immunise themselves rather than having it done by a healthcare professional.  In the event of a pandemic this would be extremely useful in helping to contain the virus.

The EU laboratory in Weybridge has announced that the bird flu virus discovered on a farm in Suffolk earlier this week is the potentially deadly H5N1 strain.

Reports have suggested that more than 2000 birds have died on the farm near Halesworth in Suffolk and further birds have been slaughtered as a precautionary measure. This is the first incident affecting farmed poultry in the UK. It is not known how the virus was introduced to the sealed rearing units at the farm but it is believed that a migrating wild bird must have found its way into the one of the sheds.

A spokesman for the Department of the Environment, Food and Rural affairs said earlier today that there was no immediate risk to humans but staff at the farm were being monitored and restrictions had been put in place to limit the movement of birds.

It is thought that the Government has placed an order for a vaccine to be used on healthcare workers in the event of an outbreak of a human form of bird flu. A stock of Tamiflu, the anti-viral of choice, has been ordered to cover around 25% of the UK population.

Cats have become infected with the H5N1 bird flu virus in Indonesia according to recently published research. A study of 500 stray cats from five sites where there have been outbreaks of the deadly virus found that one in five cats was infected. This raises fresh concerns about the disease jumping to human beings.

Bird flu might have disappeared from the news recently but the likelihood of a human pandemic has not receded along with media interest in the story. When a dead swan was found in Scotland earlier this year the whole of the world’s media seemed to go crazy but interest soon faded, even after the confirmation that the dead bird was indeed infected with the H5N1 strain of the influenza virus, as this seemed to be an isolated incident with a single migratory bird that had strayed off course.

The Global Health Research Forum believes that the highly pathogenic H5N1 strain of the virus could be with us for another decade and they believe that there is a strong possibility of this virus mutating into one which can be transferred between humans. So far a few hundred humans have been infected with the virus since 2003 but these have all been people who have come into close contact with infected poultry or wild fowl.

There are widely varying estimates of the number of deaths which might occur in a flu pandemic. The UN has said that up to 150 million people could die worldwide but the World Health Organisation has distanced itself from this figure and has suggested that between 2 million and 7.4 million people are likely to die. The UK Government has arranged to stockpile around 14 million courses of the anti-viral drug Tamiflu which is effective in preventing the spread of influenza or reducing the symptoms once contracted. The Government is also in talks about acquiring a vaccine.

Given that the Government has only made provisions for around 25% of the UK population, many people are looking to purchase Tamiflu privately for themselves and their families as a precaution. Although GPs can write a private prescription for their patients, many are unwilling to do so at this stage. As a result, many people have turned to the internet to seek advice and to purchase Tamiflu.