The response to our questions

THE Detail put five questions to the Department of Health. The full response is below.

Q: Would the department now admit it should have been more open with public information about swine flu deaths from the start of the flu season?

A: During the 2009 pandemic, additional data collection was undertaken to identify deaths related to the H1N1 2009 pandemic (swine flu) virus and these deaths were reported in the flu bulletin. This practice was specific to the pandemic and once the pandemic had been declared over by the World Health Organisation data collection was discontinued.

The Department remains of the view that reporting of individual deaths from swine flu is disproportionate and highly distressing for families of the deceased. In addition, without specific data collection any figures would be incomplete and misleading. Customary reporting of seasonal flu mortality, based on weekly registered deaths for selected respiratory illnesses, is the most robust method of assessing deaths from influenza.

However, given the level of public interest in this topic, the four UK countries are discussing the most feasible and appropriate way to report influenza deaths in order to agree a unified approach across the four countries in advance of the 2011/12 flu season.

Q: Can the department be certain that none of the Enzira vaccine was given to children under five years old? What checks were done to ensure this advice was followed? (This advice followed an increase in febrile convulsions in children in Australia who were given this brand.)

A: In Northern Ireland the Department and the Public Health Agency centrally procures seasonal flu vaccine for onward distribution to all GPs and Trusts. The procurement process was completed before the possible adverse effects associated with Enzira vaccine became known and some Enzira was included in the overall seasonal flu vaccine order for 2010/11.

However, our procurement arrangements allowed us to centrally manage vaccine distribution and when the information about Enzira became known we were able to take the following action to reduce the likelihood of its being used for children under 5 years old:

• To minimise the likelihood of Enzira being given to children under 5 years, the Department advised all relevant health professionals to avoid offering Enzira to children under five years of age. In addition, the Department arranged for all initial supplies of seasonal flu vaccine ordered by GPs from central supplies to comprise of Sanofi Pasteur vaccine and not Enzira. GPs were also advised to target their under five year old patients in the at risk groups at the start of the vaccination programme.

• A further letter was issued on 24 September, before the official launch of the vaccination programme on 1 October, regarding monitoring the safety of seasonal flu vaccines in children, which once again advised GPs that initial orders of vaccine would not include Enzira and urged GPs to target their under five patients at the start of the vaccination programme.

• The PHA arranged training sessions in advance of the vaccination programme and these were open to all health professionals involved in vaccination. At these training sessions the specific arrangements and advice regarding Enzira were explicitly covered.

• Before supplies of Enzira were issued to meet GPs’ orders, an e-mail was issued to all GP practices advising them that Enzira would now form part of their orders for seasonal flu vaccine and again advising them to avoid using this vaccine in children under five years of age. GPs were advised of arrangements for receiving an alternate brand of seasonal flu vaccine for use in children under 5.

Whilst every effort was made to minimise the likelihood of a child under five receiving Enzira vaccine, final responsibility remains with the prescriber to ensure that the most appropriate vaccine is given to each individual patient.

Q: How many people in total died from swine flu during the 20010/11 flu season and how many of them had underlying medical problems? How many people were treated for swine flu in intensive care during the 2010/11 flu season and how many of them had underlying health problems?

A: Information regarding deaths is available in the flu bulletin published by the PHA.

Information regarding the total number of patients treated for swine flu in intensive care during the 2010/11 flu season and how many of them had underlying health problems is not held by the Department.

Q: Will the department notify the public of deaths from swine flu/flu from the start of the next winter season?

A: The four UK countries are currently discussing the most feasible and appropriate way to report influenza deaths in order to agree a unified approach across the four countries in advance of the 2011/12 flu season. These discussions are ongoing.

Q: Will vaccinating healthy children under 5-years-old be considered for next season?

A: The Joint Committee on Vaccination and Immunisation (JCVI) consider all available scientific evidence and recommend which groups of the population should be offered seasonal flu vaccine each year. JCVI considered vaccination of healthy children under five years during the 2009 pandemic and again during the 2010/11 flu season and will include this group in their consideration when providing advice for 2011/12. Definitive information on groups to be vaccinated will become available on publication of the Green Book.