The new swine flu vaccine arrived at my surgery at the end of last week and our vaccination programme starts this morning. We are also three weeks into our seasonal flu campaign so it is a busy time for the practice, and a confusing one for our patients – many of whom are still uncertain as to whether they need a seasonal flu jab, the new swine flu version, or both. Here are some frequently asked questions:
Will I be able to get the swine flu jab from my practice?
Every NHS GP practice is being sent enough of the new H1N1 vaccine to immunise 500 people with a one-off dose, irrespective of the size of the practice. So, if you are registered at a small single-handed GP surgery, then your doctor may well have enough to immunise everyone on the priority list. But if you are registered at a much larger practice then you may have to wait some time if you are not in the highest priority groups. We have not been told when we are to receive further supplies.
So who is likely to be given it first?
Top of the list will be anyone aged between 6 months and 65 years from one of the groups deemed to be at higher risk of any type of flu. So this will include:
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? Anyone with long-term chest disease, including those with asthma which is severe enough to warrant regular preventative treatment.
? Those with long-term heart, kidney or liver disease.
? Anyone who has had a stroke.
? Children and adults with diabetes.
? Anyone who has a weakened immune system due to disease treatment (a group that will include everything from people taking high-dose steroids to those on chemotherapy or with HIV infection).
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Pregnant women will be next in line, followed by household contacts of patients with weakened immune systems (such as the family of cancer patients). Next will be anyone over 65 from the at-risk groups along with frontline health staff such as GPs, nurses, midwives, pharmacists, etc.
Do I need to contact my surgery?
Your surgery will contact you — probably by letter — to arrange your immunisation against swine flu, but you should contact them to make an appointment for your regular seasonal flu vaccination if you normally have one (we are halfway through our seasonal flu programme so you may well have had yours already). Both jabs can be given at the same time but the logistics are slightly complicated in that the new swine flu vaccine comes in ten-dose vials so your GP or practice nurse will need to have at least ten patients together at the same time before they can give it. If you think you are eligible but have not heard anything by mid- December, contact your surgery.
What happens if I can’t get into the surgery?
People who are eligible for vaccination, but are housebound, will be given their jab by a district nurse. The same applies to anyone in a residential or nursing home — although in my practice these jabs are often given by a visiting GP.
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Do I need both jabs?
If you normally have a flu jab, then you are almost certainly going to need both as we are expecting swine flu and seasonal flu outbreaks this winter. The one important exception is the over-65s. Everyone over 65 is routinely offered the seasonal flu jab, but only those with underlying health problems are currently eligible for the new swine flu jab. This is because older people appear to have some natural immunity to swine flu which makes them less susceptible. Equally, at the other end of the spectrum, children have no natural immunity and are often much more severely affected.
Are there any side-effects with the new vaccine?
There are two versions of the vaccine — one manufactured by GSK (Pandemrix) and one by Baxter (Celvapan) — but only the GSK version is currently available. It uses the same technology as previous flu vaccines and has undergone similar tests to show that it is safe and effective. As such, we wouldn’t expect it to be significantly different from previous flu jabs. That said, Pandemrix contains an “accelerator” (made from a combination of a fish oil and vitamin E) that prompts a stronger immune response and a sore arm at the injection site, and short-lived flu-like symptoms may be more common than with a normal flu jab. I have personal experience of only three patients — one of the GP partners at the practice, a practice nurse and one of the midwives — all three have very sore arms, and one developed fluey symptoms the day after.
Pandemrix should not be given to anyone with a severe allergy to eggs — they will have to wait for Celvapan which should be available towards the end of the month.
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Is it safe to have during pregnancy?
Pregnant women seem more susceptible to swine flu, particularly during the latter stages of pregnancy, and are up to five times more likely to need hospital treatment. Flu vaccines are not specifically tested in pregnancy but have been routinely given to pregnant women from the at-risk groups for some time. There is no evidence of additional risk during pregnancy, or in women who are breastfeeding. There have been some concerns over the use of the mercury containing preservative thiomersal in pregnancy, and it is generally recommended that pregnant women should be given vaccines that use other preservatives — although there is no evidence that thiomersal is harmful to mother or baby. All the seasonal flu vaccines this year are thiomersal-free, but the GSK swine flu vaccine does contain it.
Swine flu seems pretty mild — do I really need to be vaccinated?
Most cases of swine flu appear no worse, and often less severe, than normal seasonal flu but pregnant women and children seem at particular risk and in these groups it is potentially a very serious illness. The new H1N1 virus is likely to be around for many years and there is every chance that it could mutate to become more dangerous. Current advice is that mass immunisation is an important protective measure for people most at risk, but only time will tell just how important. Whatever happens, it is likely that the H1N1 strain is going to be incorporated into the annual flu jabs from now on.
I think I have had swine flu — do I still need the jab?
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If you were one of the early cases and properly tested to confirm the diagnosis then you will not need to be vaccinated as you will have natural immunity. But if you were one of the hundreds of thousands of people who were given a diagnosis over the phone or given Tamiflu then you should still have the jab because there is no way of knowing for sure whether you really had the virus.
What do I do if I think I have swine flu?
It depends in what part of the UK you live. In England call the National Pandemic Flu Service on 0800 1 513 100 (Textphone for anyone who is deaf or hard of hearing: 0800 1 513 200) or visit www.direct.gov.uk/swineflu . In Scotland you should call NHS 24 on 08454 24 24 24 (Textphone: 18001 08454 24 24 24) or contact your GP.
In Wales call NHS Direct Wales on 0845 46 47 (Textphone: 0845 606 46 47) or contact your GP. And in Northern Ireland call the swine flu helpline on 0800 0514 142 (Textphone: 18001 0800 0514 142) or contact your GP. You can download a free copy of Swine Flu Vaccination: what you need to know from www.direct.gov.uk/swineflu.
E-mail your questions to drmark@thetimes.co.uk