This page provides information for pharmacists on swine flu. The information here is updated regularly by staff of the Royal Pharmaceutical Society of Great Britain.
Swine flu is a respiratory disease caused by type A (H1N1) influenza viruses. It is a form of flu that originated in pigs but can be caught by, and spread among, people.
Human cases of swine flu were first reported in southern California and Texas. Cases have now also been confirmed in over 100 countries including Mexico, Canada, Australia, Japan, Chile and the United Kingdom.
On 11 June 2009, the World Health Organization (WHO) declared a pandemic as a result of ongoing community level outbreaks of swine flu in many parts of the world.
The UK strategy has moved to the treatment phase – treating the increasing numbers affected by swine flu. Contact tracing and prophylaxis in all regions has ceased. GPs will now provide clinical diagnosis of cases rather than awaiting laboratory test results; and Primary Care Organisations (PCOs) will now begin to establish antiviral collection points where necessary. This could be a pharmacy or a community centre.
The RPSGB is being contacted by a number of PCOs to identify pharmacists in their area, as part of their local planning. Although the Register is publicly available, the individual contact details of pharmacists are not. As such, the Society is advising all registrants to contact their local PCO direct to offer their services.
To obtain the contact details of your local PCO please visit the following websites:
England
NHS Choices Services Directory
Scotland
NHS Scotland
Wales
NHS Wales
The World Health Organization (WHO) has a six-phased approach to pandemics. Phases 1–3 correlate with preparedness, including capacity development and response planning activities, while Phases 4–6 signal the need for response and mitigation efforts. For further information visit the WHO website.
The current phase of pandemic alert is 6, the pandemic phase, which means swine flu is now spreading in communities in several countries. This decision by the WHO reflects the geographic spread of the virus and not its severity.
At this time, WHO considers the overall severity of the influenza pandemic to be moderate. This assessment is based on scientific evidence available to WHO, as well as input from its Member States on the pandemic's impact on their health systems, and their social and economic functioning.
The moderate assessment reflects that:
WHO is concerned about current patterns of serious cases and deaths occurring primarily among young people, including the previously healthy and those with pre-existing medical conditions or pregnancy.
Large outbreaks of disease have not yet been reported in many countries, and the full clinical spectrum of disease is not yet known.
UK alert levels will not automatically come into play at WHO Phase 6.
The UK strategy has moved to the treatment phase. Contact tracing and prophylaxis in all regions has ceased. GPs will provide clinical diagnosis of cases rather than awaiting laboratory test results; and Primary Care Organisations (PCO) will establish antiviral collection points where necessary. This could be a pharmacy or a community centre. Please contact your local PCO for further information (see the section ‘swine flu’ above).
Cases of swine flu in the UK have so far experienced mild symptoms and make a rapid and full recovery. However, a small minority have been more severe.
The Department of Health is monitoring the situation closely and will respond appropriately should the situation change.
The symptoms of swine flu in people are similar to the symptoms of regular human seasonal flu infection and include fever, fatigue, lack of appetite, coughing and sore throat. Some people with swine flu have also reported vomiting and diarrhoea.
Individuals who think they may have swine flu should first go online and check their symptoms on www.nhs.uk or call the swine flu information line on 0800 1 513 513. If they are still concerned they should call their GP who can provide a diagnosis over the phone and organise appropriate treatment.
The human swine flu H1N1 virus can be treated with the antiviral drugs oseltamavir (Tamiflu) and zanamivir (Relenza) to lessen the symptoms of pandemic flu. To be effective the course should be started within 36-48 hours of the onset of symptoms.
Antivirals will help to:
Antivirals are not a cure, but they lessen the symptoms and aid recovery.
People who have the swine flu virus will be offered antivirals. However, it remains a matter of clinical discretion to decide whether antivirals should be prescribed in individual cases – for example where doctors are likely to be contacted by patients with coughs, colds and the worried well, in addition to those with swine flu.
The Department of Health will be issuing guidance to doctors to ensure that those people at higher risk – including those with chronic lung, kidney or heart disease, under fives, over 65s and pregnant women – get priority access to antivirals, within 48 hours of the onset of symptoms.
This is a cautious approach. Many people will be able to recover from swine flu without the need for antivirals and may therefore choose not to seek treatment. But a doctor faced with a symptomatic patient can not yet predict with certainty the course of their illness and whether or not they will be in the small proportion who may become more seriously ill.
If people think they have swine flu, they should first go online and check their symptoms on www.nhs.uk or call the swine flu information line on 0800 1 513 513. If they are still concerned, they should then call their GP, who can provide a diagnosis over the phone. People should not go to A&E if they suspect they have swine flu.
If swine flu is confirmed, patients will be given an authorisation voucher, which a flu friend can take to an antiviral collection point to pick up their antivirals. This may be a pharmacy or a community centre.
As cases rise further, a system where cases are diagnosed and dealt with by the National Pandemic Flu Service will be implemented. This will take the pressure off GPs by allowing people to be diagnosed and given their antiviral vouchers either online or via a central call centre.
The Department of Health has issued guidance for clinicians about the swine flu vaccination programme. It combines information about the vaccines and the proposed programme for their administration with evidence from a variety of peer-reviewed sources. Click here to view the document, Clinical professionals brief on swine flu vaccination.
Some individuals are at increased risk of severe or complicated illness if they suffer from influenza. The Department of Health has issued guidance that provides advice on protecting healthcare employees who are pregnant or in one of the other at risk groups identified for swine flu. Click here to view the document, Health and social care workers and pandemic influenza: information for staff who are pregnant or in other at-risk groups
To help relieve symptoms of swine flu people should:
As of 6 July, a new system has been put in place for reporting suspected side-effects to the H1N1 swine flu antivirals, Tamiflu and Relenza.
The Medicines and Healthcare products Regulatory Agency (MHRA), who are responsible for ensuring that medicines and medical devices in the UK work and are acceptably safe, collect information on suspected side-effects from healthcare professionals and members of the public via their national reporting system, the Yellow Card Scheme. However, a separate system has been implemented for reporting suspected side-effects to Tamiflu and Relenza - the Swine Flu ADR Portal.
All healthcare professionals have been issued with a letter from the MHRA providing them with information about the new Portal and how to report any suspected side-effects to Tamiflu and Relenza.There is a large amount of confusion around the current supply of antivirals. The supply is controlled very tightly. All supply and distribution is maintained in the UK by Primary Care Organisations. Antivirals are not available from manufacturers and wholesalers directly.
Arrangements have been put in place with local healthcare services for antivirals to be made available to those who need them.
People with symptoms and others at risk will be assessed by their GP over the phone. If antivirals are required, patients will be given an authorization voucher, which a flu friend can take to an antiviral collection point to pick up their antivirals. This may be a pharmacy or a community centre. Please contact your local PCO for further information (see the section ‘swine flu’ above).
The current process for distribution of Tamiflu or Relenza can differ throughout Great Britain. Country-specific information is outlined below:
Antiviral medication, Tamiflu or Relenza, is only indicated for supply on the NHS, for individuals who are suspected to have flu on clinical grounds and on travel or contact history. Seasonal flu finished circulating in the UK several weeks ago.
Health protection units (HPUs) have supplies of antivirals to be used in the initial mitigation steps for individuals who comply with the details described in the Health Protection Agency (HPA) algorithm, which can be downloaded from the Health Protection Agency website.
For further information on current policy and future antiviral distribution refer to guidance on the Central Alerting System.
Letter to pharmacists: For a letter from the RPSGB to English pharmacists, sent on 1 May 2009, click here
From Monday 20th July the supply mechanism for antiviral in Wales has changed.
Local Health Boards have now engaged Community Pharmacy and distributed an initial bundle of antiviral stock to each pharmacy. The regulations have also been amended to enable antivirals to be prescribed on WP10 forms and dispensed in the normal way from Community Pharmacies. Local Health Boards may also have engaged Dispensing Doctors in this scheme.
Please note that this excludes children under one year old for whom access to oseltamivir suspension remains through hospital pharmacy during office hours and GP Out of Hours providers at evenings and weekends.
The Emergency Co-ordinating centre is operational between 8am and 6pm to deal with any queries from the service (e-mail ECCW-Health@wales.gsi.gov.uk, 02920 825708 or 02920 825710).
Letter from CMO: For a letter from the Chief Medical Officer, Wales, sent 22 July 2009, click here.
Letter to pharmacists: For a letter from the Welsh Assembly Government to Welsh pharmacists, sent on 17 July 2009, click here.
Letter to community pharmacists: For a letter on engaging community pharmacy in the response to H1N1 influenza, sent July 2009, click here.
Health protection advice for community pharmacists: For a guidance from the National Public Health Service for Wales, sent on 1 July 2009, click here.
Where a patient presents with a private prescription for Tamiflu or Relenza, and you have existing stocks, please consider:
To find the nearest health protection unit or distribution centre in England visit the Health Protection Agency website.
It is possible unscrupulous traders may take advantage of the public’s fears by selling counterfeit drugs over the internet. In particular, people should be advised not to buy medicines from unknown sources or respond to spam e-mails offering to supply Tamiflu or Relenza.
Drugs offered in this way may turn out to be counterfeit and could contain anything from sugar to more dangerous substances that can cause serious risks to health.
The public should also be reminded it is never a good idea to obtain a prescription-only medicine without a valid prescription. The medicine may not be suitable for the individual and could result in unpleasant side effects or serious health risks.
Most patients previously reported to have swine flu recovered fully from the disease without requiring medical attention and without antiviral medicines.
Swine flu viruses are not transmitted by food. There is no risk of catching the illness from eating properly handled and cooked pork or pork products.
To reduce the risk of catching or spreading swine flu it is good practice to follow respiratory and hand hygiene advice, such as:
The public is being advised to confirm a network of 'flu friends' – friends and relatives who could help if they fall ill. These 'flu friends' could collect medicines and other supplies for so people with the flu don't have to leave home and possibly spread the virus.
Members of the public are advised to look at NHS Choices or NHS24 for further advice. They can also call the Swine Flu Information helpline on 0800 1 513 513 and see the Directgov website for the latest updates.
A joint statement has been prepared by the National Pharmacy Association, Royal Pharmaceutical Society of Great Britain, Pharmaceutical Services Negotiations Committee, Company Chemists Association and the Guild of Healthcare Pharmacists. It is a joint update about Influenza A (H1N1) also known as swine flu. A number of legislative changes have been made to ensure the continuity of medicines supply, including changes to Emergency Supplies, the establishment of collection points for antivirals and prescription charges for antivirals in England.
To view the update, click here
The RPSGB recently issued a Law and Ethics Bulletin (LEB) detailing the changes to emergency supply legislation that is now in force.
The situation is evolving on a daily basis. A leaflet containing advice about the basic steps people can take to avoid infection has been distributed to every household in the country.
For the very latest updates, sources of accurate information for professionals and the public include:
The RPSGB is working closely with the Department of Health (DH), Medicines and Healthcare products Regulatory Agency (MHRA) and other pharmacy bodies on a number of issues around:
Pharmacists need to feel confident that they are working within agreed standards and principles, and will not be subject to criticism because of difficult decisions they may need to make, or the standards of care provided, during a pandemic.
All pharmacists will be expected to work under the current Code of Ethics and the Standards that support it. However, there are aspects of emergency service provision that might give rise to a complaint in 'normal' service provision, eg, refusal to supply. Should complaints reach the RPSGB then each complaint would be reviewed and managed appropriately, with due consideration given to any extraordinary circumstances caused by a pandemic situation.
For questions and answers for pharmacists on swine flu, click here
For recent press releases from the RPSGB on swine flu, click here