Dear Colleague,

Most recent data from the sentinel network suggests that Pandemic H1N1 infection levels remain high in the population, but appear to be dropping slightly. In the short term this means that we will most likely continue to see significant numbers of cases over the next few weeks. A later resurgence in the rates cannot be excluded.

Groups of particular concern, where higher levels of morbidity and mortality have been occurring, include pregnant women and people with chronic neurological or developmental problems such as Downs Syndrome and Cerebral Palsy. These are amongst the groups prioritised for vaccination and should also be treated with Tamiflu where appropriate. Early initiation of Tamiflu has been associated with lower levels of complications, and international experience has shown a consistent association between delays in initiating antivirals and fatal outcomes. The algorithm for Primary Care Management is available on the HPSC website (this algorithm is no longer available, July 2010).

It is also worth remembering that the non-specific acute febrile presentations of influenza and other conditions such as meningococcal infections can be similar, and that increased levels of meningococcal infection have been observed to occur following influenza outbreaks.

The advice about vaccinating pregnant women has been consistently highlighted and endorsed by many bodies, including the CDC, WHO, RCOG, RCPI and ICGP. Both available vaccines are licensed and safe for use in pregnancy by the Irish Medicines Board and the European Medicines Evaluation Agency. Further details are available on the Health Service Executive Immunisation website (this algorithm is no longer available, July 2010).

The decision on the need for 2nd doses of Pandemic vaccines has been announced and a bulletin on this and other vaccine related issues is being circulated by HSE. It is posted on ICGP website and is available by clicking this link.

Useful advice on management of secondary infections in children has also been produced and updated and is available on the HPSC website (this algorithm is no longer available, July 2010). A similar document for management of adults will follow shortly and will be posted on the same page. Remember to refresh the browser page for the most recent version.