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Flu: why this year’s outbreak is one of the worst

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by NursingNotes.
Flu: why this year’s outbreak is one of the worst

The UK is being hit with one of the worst flu seasons in recent decades. A total of 664 hospital admissions and 85 confirmed deaths have been reported since the beginning of winter 2017.

The British media have blamed “Aussie flu” for the outbreak. The truth is, there is not just one flu strain we should be worried about, and “Aussie flu” is a bit of a misnomer.

First, a bit about flu strains. There isn’t really a flu virus. Flu virus is a name we give a group of four closely related viruses: influenza A, influenza B, influenza C and influenza D. While humans can’t catch influenza D (that’s for pigs and cows), we can be infected with influenza A, B and C. Public health officials, however, are less worried about influenza C as it isn’t a major cause of illness. But influenza A and B are a real worry.

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Influenza A has been found in – and causes disease in – lots of animals, including birds, bats, dogs, pigs and penguins. One of the major worries is pandemic influenza, where a new virus jumps from animals and spreads across the world easily because we haven’t had a chance to build up immunity to that new type.

Influenzas A and B can be subdivided even further by the proteins they carry on their surface – hemagglutinin (H) and neuraminidase (N). These proteins help the virus identify the right cells to infect.

For influenza A there are 18 Hs and 11 Ns identified so far. Hence we get names such as H1N1 for swine flu or H5N1 for bird flu. Contrast this with the fact that there are really only two lineages of influenza B, named after cities in Japan and Australia: Yamagata and Victoria, respectively.

The Hs and Ns are continuously evolving in response to our immune systems, which recognise and make antibodies to stop the virus taking hold. A vaccine usually supplies the H and N proteins without the potentially dangerous virus. Scientists also continuously track the H and N of circulating influenza viruses and adjust the vaccine to match what’s out there. This is the basis for flu vaccination and why you have to get a new vaccine jab every year.

Enter ‘Aussie flu’

“Aussie flu” refers to one kind of influenza A virus strain, the H3N2 strain.

The southern hemisphere, including Australia, just experienced one of its worst influenza seasons in recent history and this is the virus that has reached British shores. But we don’t actually know where the virus originated from. All we can say is, it probably wasn’t from Australia.

One place it is more likely to have come from is the sub-tropical regions that do not have winter seasons. These regions do not suffer from the same large flu epidemics that temperate countries like the UK and Australia have (we don’t know why, but some scientists have suggested it’s to do with temperature or humidity), but have continuous lower-level circulation of flu that allows influenza viruses to persist between winters.

What’s worrying about this season is the experience Australia had last flu season. Australia was hit particularly hard by influenza virus H3N2. H3N2 is a typical seasonal flu strain – like H1N1 – but it tends to be more difficult to control.

There are three red flags this flu season, and they are that H3N2 viruses typically causes more hospitalisations and deaths in older people, there are difficulties in producing effective H3N2 vaccines (explained below), and there’s more than just H3N2 to consider, especially in the UK this year.

Although good against the other strains, this season the vaccine is about 20% protective against H3N2 viruses (not great, but better than nothing) as the virus changed unavoidably during production. This is due to a quirk of how flu vaccines are produced. They are grown in chicken eggs, and then inactivated before being used in vaccines.

Flu viruses mutate quickly and they mutate to adapt to their environment. Of course, a chicken egg is a different environment to a human body, so the end result may be a virus that’s not best suited to a flu vaccine. This appears to have been what happened with the latest H3N2 vaccine.

Seasonal flu epidemics are usually caused by a mixed bag of viruses. This year, the mix is so far mainly shared between H3N2 and influenza B.

What’s worse is that this increase in proportion of influenza B makes it more difficult to protect from because the most popular vaccine in the UK is a “trivalent” that protects against three flu viruses (H1N1, H3N2 and one of the two kinds of influenza B). This year, though, the other type of influenza B (Yamagata) is more common meaning that those with the trivalent vaccine will be protected less, although they would likely get some cross-influenza B protection.

One vaccine to rule them all

Influenza is incredibly diverse. And this diversity can have devastating consequences for human and animal health. Although our ability to track flu, predict the viruses making up the next season and produce safe and effective vaccines is improving, we are always playing catch up. Efforts to produce a universal flu vaccine are, however, being pursued by scientists across the world. The idea would be that a single vaccine given a few times during your life would protect you from any flu virus, irrespective of H, N, A or B.

The ConversationBut, until then, you can defend yourself and your loved ones from the flu this year by getting your vaccine, practising good personal hygiene, such as handwashing, and avoiding crowded spaces if you are experiencing flu-like symptoms.

Connor Bamford, Virologist, University of Glasgow and Julien Amat, PhD Candidate, University of Glasgow. This article was originally published on The Conversation. Read the original article.

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Patients will suffer as NHS deficit spirals out of control

NHSI blamed acute hospitals for the overspend due to an increased patient demand.

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by Chloe Dawson.
Patients will suffer as NHS deficit spirals out of control

NHS trusts in England have reported a combined financial deficit of nearly twice the amount planned.

The figures, released by NHS Improvement, showed a system under systematic strain and an NHS deficit of £960m in the last financial year - nearly double what the organisation had planned for.

NHS Improvement pointed out that 156 of the 234 trusts finished the year either reaching or exceeding their financial targets and said that acute hospitals were responsible for the overspend due to an increased patient demand. It added that other NHS organisations including ambulance services and mental health trusts had collectively underspent.

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During January, February and March alone, there were 1.1 million people who attended A&E who needed to be admitted for treatment – 70,000 more than the same period last year.

Heavily reliance on temporary workers.

The Royal College of Nursing has said that the chronic staffing shortage is partly to blame for the overspend with high vacancy rates and a heavy reliance on expensive temporary workers.

Offical figures show the sector is faced with 92,694 staffing vacancies - including 35,794 nursing vacancies and 9,982 medical vacancies.

Janet Davies, Chief Executive and General Secretary of the Royal College of Nursing, said: “These figures reveal both sides of the same coin – a cash-starved NHS forced to run without enough staff to treat people safely. For as long as hospitals remain £1 billion in the red, patients will pay a heavy price.

“The number of nurses missing from England’s NHS remains stubbornly high – hospitals cannot afford to recruit and inadequate numbers are being trained too.

“Theresa May and Philip Hammond cannot allow this financial knife-edge to continue. Whether the Chancellor announces the extra funding in time for the NHS anniversary this summer or waits until the Autumn Budget, it must be both substantial and genuinely new money. It would not be enough just to wipe these deficits – health and care budgets must be boosted to reflect genuine demand. Anything less exposes patients to unacceptable risks and leaves care increasingly unsafe.”

'Incredible resilience'

Ian Dalton, Chief executive of NHS Improvement, said: "Despite epic challenges, NHS staff up and down the country displayed incredible resilience and saw more patients than ever before within four hours.

"More than two-thirds of providers ended the year on budget or better than planned. Given rising demand and record vacancies, this is an important achievement."

Chris Hopson, Chief executive of NHS Providers claims a 5% annual increase in NHS funding is needed to maintain the same levels of care seen in Europe.

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Primary Care

RCN launches first-ever protocol for animals in healthcare

The protocol will help hospitals and other health settings introduce animals into the environment.

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by Ian Snug.
RCN launches first-ever protocol for animals in healthcare

The Royal College of Nursing has launched the first-ever nationwide protocol for animals in health care.

The protocol will provide an evidence-based best practice criteria so that hospitals and other health settings can introduce animals into the care environment.

By following the RCN’s protocol, services will be able to ensure the safety of patients and healthcare staff as well as the animals and their owners, whilst allowing patients to reap the benefits that interaction with animals can bring.

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The project was prompted by an RCN survey last year which found that although the majority of respondents thought animals were hugely beneficial to patients, most nurses said animals were not allowed in their workplace.

Animals improve care.

Research has shown how animals can improve patient care. The RCN survey found that nine out of ten (90%) nurses believe animals can improve the health of patients with depression and other mental health problems, and 60% said the presence of animals could speed patient recovery.

At the launch event, Lyndsey Uglow, a pioneer in animal therapy, will discuss how she and her golden retriever Leo have changed the lives of hundreds of children at Southampton Hospital.

The development of the new protocol was led by RCN professional lead for long-term conditions and end-of-life care, Amanda Cheesley.

Amanda said: “Anyone who’s worked in this area can see the amazing impact animals have on the health of adults and children alike. However, there are so many myths around the dangers of having animals in health care settings that most organisations are too concerned to try it out.

“This protocol will help to dispel these fears by supporting hospitals to include animals in the care they deliver in a safe and professional way. We hope that it will encourage all health services to consider how animals can help their patients and help us to remove the taboo from what is a really remarkable area of care.”

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MPs to debate 'co-pay' system for the NHS

The bill would see an increase in the use of 'co-payment' charges throughout the NHS.

Published on

by Ian Snug.
MPs to debate 'co-pay' system for the NHS

The proposed bill would see the NHS set charge fees for some services.

Sir Christopher Chope OBE, a Barrister and the Conservative MP for Christchurch, is proposing a bill that would see an increase in the use of 'co-payment' charges throughout the National Health Service (NHS).

Co-payment is currently used for dental treatments, eye tests and prescription charges but experts have warned that the bill would open the floodgates to charging for a range of other services including GPs appointments and minor operations.

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Recent changes to NHS prescribing guidelines has shown that the 'co-pay' system is far from perfect.

MPs to debate 'co-pay' system for the NHS

Christopher Chope

The National Health Service (Co-Funding and CoPayment) Bill would “make provision for co-funding and for the extension of co-payment for NHS services in England” and this will be the second reading of the bill.

MPs are set to debate the proposed bill today.

Justin Madders MP, Labour’s Shadow Health Minister, said: “Once again we see the Tories’ true colours.

“At a time when the NHS is going through the biggest funding squeeze in its history and more than four million people are waiting for treatment, Tory MPs are proposing a two-tier system where those who can afford it get treated first.

“Labour’s first priority will be to give the NHS the funding it needs to protect an NHS free at the point of use for everyone who needs it.”

Sir Chope has previously tabled a range of other controversial bills.

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