Are you at risk from the ‘flu this winter? Read our interview with Dr Jonathan Pittard



Do you need a flu jab?

Do you need a flu jab?

More than half of Doctors think the main reason at-risk patients do not take up flu vaccination is because they are concerned the vaccine itself could give them flu-like symptoms, according to results of a recent survey.

53 per cent of professionals polled rated this as the top reason why they think at-risk patients – including over 65s, pregnant women and those with weakened immune systems because of other diseases – miss out on vaccination. It ranked in the top five reasons among 94 per cent of respondents.

The next biggest concern for HCPs was that patients who have not previously had flu do not consider themselves at risk, with 86 per cent placing this in the top five reasons patients miss the jab. And 76 per cent said patients being unaware of the increased risk of complications from flu were among the top five reasons.

Flu is an infectious viral illness spread by coughs and sneezes. It is different from the common cold because it is caused by different viruses and tends to result in more severe and long-lasting symptoms. Flu can be prevented through good hygiene, vaccination and, in some cases, antiviral medication.

During the last flu season, uptake of the flu vaccine varied in at risk groups with just around 40% of pregnant women and 73% of over 65s being immunised across England.


To find out more we contacted an interview with Dr Jonathan Pittard, a UK based family doctor.

PATENTTALK.ORG: Thanks for taking time to talk us Dr Pittard, can you start by telling us what influenza is?

DR PITTARD: Well influenza is a viral illness of several different strengths but you only get one at a time. Essentially it gives you a very high fever, and a very bad headache and a very bad muscle ache. So essentially for 4 or 5 days you are sneezing and snuffling a bit, you can hardly stand up, you can get to the bathroom and back to your bed and you feel pretty dreadful. It is a bit like having malaria so it is way worse than a cold.

PATENTTALK.ORG: And, what are the different types of flu and how do they infect people?

DR PITTARD: There are two classifications; there is A influenza and B influenza.  B has by reputation to be slightly more severe. The most recent A one that people will be familiar with would be swine flu, which came out in 2009-10.  We vaccinated a lot of pregnant women then because it was worst in pregnancy.  The actual illness I had in April of that year and happily it was just for the Friday, Saturday, Sunday so I didn’t miss any work but the current vaccine has a 2009 strain in and two from 2012.  One of A vaccine and one of B virus and they were identified in the States. In the case of Swine flu it came up from Mexico from pigs to humans and that’s how it has picked up.  So the World Health Organisation keeps an eye out for this like Sherlock Holmes and spots what the trends would be; the virus strains that we haven’t had in Europe and it will put the manufacturers on advice to make the vaccine to anticipate the ones we haven’t had.

PATENTTALK.ORG: Could you just tell us a little bit about the particular danger posed by the different strains of flu,  such as bird flu.

DR PITTARD: Well the biology of it seems that these viruses, similar with the Ebola virus, they seem to get into animal systems and seem to mutate there. And then there are places in China in case of bird flu there are a lot of poorer Chinese who will live with chickens in their house and because chickens are kind of valuable they keep them under their beds, you can well imagine if you stay with a chicken long enough it may share one of its viruses with you, and when the jump is made from avian bird flu to a human often the human system reacts very badly to it, and there have been one or two deaths.  So it is quite interesting biology.  In the case of the Ebola virus, it was bush meat and people were eating these animals and getting these animal viruses.

PATENTTALK.ORG: Can you just briefly outline how the flu jab works?

DR PITTARD: What happens is the myth that the survey shows, people object to the flu vaccine on the one ground is maybe that they think it will give them the flu.  Some viruses are actively vaccinated into us.  Polio used like that – it was audited in a way that it didn’t make you ill but it gave you immunity for life.  With the flu vaccine they extract the infectious part and they just give you the virus ‘skin’, to give it to you in simpler terms and it then prompts your immune system to look out for that virus when you meet it live in the future. So after about ten days you meet the live virus your immune system won’t take a hold because it will recognise the skin, the armour if you like, and will destroy it before it starts with the  Interferon that is the body’s anti-viral.  So it is a dead vaccine, it won’t give you the flu.

PATENTTALK.ORG: So is it a myth, then – that you may develop symptoms of flu by having the jab?

DR PITTARD: Yes, I think what happens is when people go to the doctors they pick up a virus in winter, they are incubating it they get hit in the waiting room or the supermarket on the way home, and it coincides with the flu vaccine and for a few patients they say “Oh, well that is what has given me the flu, I should not have had the flu vaccine”, and so they become adverse to it.  Most of our patients don’t subscribe to that but that is what the survey, Ipsos Moray GSK Survey showed.  And so we are really keen to expose that as a myth.

PATENTTALK.ORG: Are there any possible complications from having the flu vaccine?

DR PITTARD: Well the headline objection that’s very rare is that if a patient has true intolerance to eggs, and you might not like eggs, you might not like egg soufflé or egg fried rice or omelettes but that is not an allergy an allergy is where your tongue swells up, your eyes close, you need adrenalin, and you get very asthmatic I mean that is very rare to eggs it is probably as rare as being allergic to milk but because the vaccine is prepared using live hens eggs which is un-purified there is a theoretical objection to that, but that is the only headline issue. If for example you are very allergic to rare ingredients in the flu vaccine, the preservatives in the other vaccines you have had a reaction to tetanus, you have had a reaction to pneumonia vaccine, then possibly your doctor will know that.  These are very rare 1 in 10,000 or 1 in 1,000,000 cases.  For the bulk of us, none of that applies. If you can tolerate eggs, you can tolerate the flu vaccine.

PATENTTALK.ORG: Who is particularly at risk from believing in these myths?

DR PITTARD: The best way to answer that is the “at risk” population. Most GPs are concerned with the over 65’s because you tolerate flu worse and worse as you get older.  The rest of your biology is compromised by aging; heart, lungs and so on.  You are more likely to get pneumonia and you are less likely to be able to look after yourself.  Younger patients that battle on are a bit stronger I guess.  So the national policy is to vaccinate the over 65’s and also vaccinate people with pneumonia and bronchitis risks, diabetic risks, heart disease risks and one of the two groups like care workers and ambulance drivers.  These are the people that need the vaccine and they are the ones that are likely to object for grounds of getting the flu from the flu vaccine, which is not true.  The other objections that the survey showed is they thought that they never got the flu so they didn’t need it. Of course eventually, it is like Russian roulette, they will get it.

PATENTTALK.ORG: Final question, what is your advice to anyone who might be worried about getting the flu?

DR PITTARD: Well, the national policy which had thousands of patients seeing their GP’s in October / November and the GP’s keep the flu vaccine in their surgery, their special clinics, and kept in touch with their practice, if you have moved area just talk to the reception staff and they will make it very easy for you to get your vaccine.  If you are concerned that you may have a particular risk then you can have a consultation with your GP by phone for example, and they can often phone you back, book an appointment to talk about it or if you are outside of the risk group that the NHS will vaccinate you then you can still go to pharmacy chains and buy the vaccine for about £10, maybe less, and have it yourself. There are very few contraindications of having this, it is a very safe procedure.

 

Ebola crisis – Frequently asked questions about the Ebola crisis from the World Health Organisation.


Ebola crisis

Ebola crisis

Yesterday the World Health Organisation shared some responses to a number of frequently asked questions they have received from journalists and members of the public about the ongoing Ebola crisis.

At PatientTalk we thought it would be useful to share these with our readers.

Are the Ebola outbreaks in Nigeria and Senegal over?

Not quite yet.

If the active surveillance for new cases that is currently in place continues, and no new cases are detected, WHO will declare the end of the outbreak of Ebola virus disease in Senegal on Friday 17 October. Likewise, Nigeria is expected to have passed through the requisite 42 days, with active surveillance for new cases in place and none detected, on Monday 20 October.


For Nigeria, WHO confirms that tracing of people known to have contact with an Ebola patient reached 100% in Lagos and 98% in Port Harcourt. In a piece of world-class epidemiological detective work, all confirmed cases in Nigeria were eventually linked back to the Liberian air traveller who introduced the virus into the country on 20 July.

The anticipated declaration by WHO that the outbreaks in these 2 countries are over will give the world some welcome news in an epidemic that elsewhere remains out of control in 3 West African nations.

In Guinea, Liberia, and Sierra Leone, new cases continue to explode in areas that looked like they were coming under control. An unusual characteristic of this epidemic is a persistent cyclical pattern of gradual dips in the number of new cases, followed by sudden flare-ups. WHO epidemiologists see no signs that the outbreaks in any of these 3 countries are coming under control.

How does WHO declare the end of an Ebola outbreak?

A WHO subcommittee on surveillance, epidemiology, and laboratory testing is responsible for establishing the date of the end of an Ebola outbreak.

The date is fixed according to rigorous epidemiological criteria that include the date when the last case with a high-risk exposure completes 21 days of close medical monitoring and tests negative for the virus.

According to WHO recommendations, health care workers who have attended patients or cleaned their rooms should be considered as “close contacts” and monitored for 21 days after the last exposure, even if their contact with a patient occurred when they were fully protected by wearing personal protective equipment.

For health care workers, the date of the “last infectious contact” is the day when the last patient in a health facility tests negative using a real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test.

For WHO to declare an Ebola outbreak over, a country must pass through 42 days, with active surveillance demonstrably in place, supported by good diagnostic capacity, and with no new cases detected. Active surveillance is essential to detect chains of transmission that might otherwise remain hidden.

Incubation period

The period of 42 days, with active case-finding in place, is twice the maximum incubation period for Ebola virus disease and is considered by WHO as sufficient to generate confidence in a declaration that an Ebola outbreak has ended.

Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval. WHO is therefore confident that detection of no new cases, with active surveillance in place, throughout this 42-day period means that an Ebola outbreak is indeed over.

The announcement that the outbreaks are over, in line with the dates fixed by the subcommittee on surveillance, epidemiology, and laboratory testing, is made by the governments of the affected countries in close collaboration with WHO and its international partners.

WHO recommendations for testing for Ebola virus disease and confirming a case

WHO is alarmed by media reports of suspected Ebola cases imported into new countries that are said, by government officials or ministries of health, to be discarded as “negative” within hours after the suspected case enters the country.

Such rapid determination of infection status is impossible, casting grave doubts on some of the official information that is being communicated to the public and the media.
• For early detection of Ebola virus in suspected or probable cases, detection of viral ribonucleic acid (RNA) or viral antigen are the recommended tests.
• Laboratory-confirmed cases must test positive for the presence of the Ebola virus, either by detection of viral RNA by RT-PCR, and/or by detection of Ebola antigen by a specific Antigen detection test, and/or by detection of immunoglobulin M (IgM) antibodies directed against Ebola.
• Two negative RT-PCR test results, at least 48 hours apart, are required for a clinically asymptomatic patient to be discharged from hospital, or for a suspected Ebola case to be discarded as testing negative for the virus.
• Laboratory results should be communicated to WHO as quickly as possible, in addition to reporting under the requirements and within the timelines set out in the International Health Regulations, which are administered by WHO.

WHO recommends that the first 25 positive cases and 50 negative specimens detected by a country without a recognized national reference viral haemorrhagic fever laboratory should be sent for secondary confirmatory testing to a WHO collaborating centre, designed as specialized in the safe detection (at biosafety level IV) of viral haemorrhagic fevers.

Similarly, for countries with a national reference laboratory for viral haemorrhagic fevers, the initial positive cases should also be sent to a WHO collaborating centre for confirmation.

If results are concordant, laboratory results reported from the national reference laboratory would be accepted by WHO.
• For more information read WHO recommendations on laboratory guidance for the diagnosis of Ebola virus disease

Ebola and Spain – World Health Organisation comments on Spanish Ebola Crisis


Ebola Crisis

Ebola Crisis

Just in from WHO.  For your information.

“On 6 October 2014, the World Health Organization (WHO) was informed of the first confirmed autochthonous case of Ebola virus disease (EVD) in Spain. This case represents the first human-to-human transmission of EVD outside Africa.

The case is a female healthcare worker with no travel history to West Africa but who participated in the medical care of an EVD case in a Spanish citizen, who had been infected in Sierra Leone and evacuated to Madrid, Spain on 22 September 2014 and who died on 25 September 2014. She was in contact with the repatriated EVD case twice; on 24 and 25 September 2014. On both occasions she is reported to have worn appropriate personal protection equipment (PPE).

Following the Spanish national protocol for EVD cases, the healthcare worker was considered a low risk contact and monitored accordingly. The female case developed a fever on 29 September 2014 and was admitted into isolation on 6 October 2014 at Alcorcon Hospital in Madrid. The case was then transferred to La Paz-Carlos III Hospital in Madrid and is being treated under isolation.

Samples were collected and sent for testing to the National Reference Laboratory on 6 October 2014. Results were positive for Ebola virus on the same day.

The Spanish public health authorities are conducting an investigation to elucidate the mode of transmission. Identification of close contacts for daily monitoring for 21 days after exposure is underway for the recent case and is continuing for contacts of the Spanish citizen who was treated in Spain.


As for all countries reporting EVD cases, future WHO updates on EVD in Spain will not be posted on the Disease Outbreak News. Further information will be available in WHO’s Ebola situation reports which provide regular updates on the WHO response:

WHO does not recommend any travel or trade restrictions to be applied by countries except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD. Contacts do not include properly-protected health-care workers and laboratory staff.

Temporary recommendations from the Emergency Committee with regard to actions to be taken by countries can be found at:

“Risk of Ebola spreading in Europe is very low” say World Health Authority


Ebola Crisis

Ebola Crisis

We have covered the Ebola virus before but with recent developments in the USA and the European Union we think it would be useful to extend our coverage during the crisis.

We would also be very interested in finding out what your ideas are to stop the spread of the virus. That being said the World Health Organisation shared the following with us yesterday. “Sporadic cases of Ebola virus disease in Europe are unavoidable. This is due to travel between Europe and affected countries.

However, the risk of spread of Ebola in Europe is avoidable and extremely low. European countries are among the best prepared in the world to respond to viral haemorrhagic fever (VHF) including Ebola.

There is a risk of accidental contamination for people exposed to Ebola patients: this risk can be and must be mitigated with strict infection control measures. Health care workers are on the frontline of the Ebola fight and they are those most at risk of infection. They need to be protected and supported by all means.

All countries have protocols and procedures that must be implemented when a case is suspected and it is important that these are followed diligently. WHO is, as always, ready to provide help and support where requested.”

The latest edition of the Ebola Response Roadmap Situation Report was published yesterday. You can read it here.