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December 2019

Circulating flu impacts general practice workload



Weekly consultation rates for flu-like illnesses soared in general practice in the last weeks of 2019, with influenza activity continuing to increase across the health service.

The GP consultation rate increased by 21% to 16 per 100,000 population in week 51, 2019, compared with 16 per 100,000 in the previous week, and 13.1 the week before.

According to the European Centre of Disease control, flu has the highest burden of any infectious disease, and has a significant impact on workload in general practices every winter.

RCGP chair Professor Martin Marshall said: ‘Winter is certainly upon us and our Research and Surveillance Centre figures show rates of flu-like illness are higher than the five year average – although still within levels that would be expected at this time of year.’

There were reports of 94 new acute respiratory outbreaks in the last week of the year, mostly in care homes and schools. Most cases have been attributed to influenza A.

The hospitalisation rate is described as at moderate intensity levels, with 7.23 admissions per 100,000 population. ICU and HDU admission rates are also at moderate intensity, but so far no statistically significant excess all-cause mortality has been reported.

The CMO approved prescription of antiviral drugs on the NHS for the treatment and prophylaxis of flu on 31 December 2019. These drugs are not available in primary care until authorised, once flu has been confirmed to be in circulation in the community, although they can be prescribed in secondary care at any time for patients with suspected seasonal flu infection.

The UK may not have seen the worst of the flu season yet, given the relatively mild winter so far. But in the US, the Centers for Disease Control report that so far this season seasonal flu activity is high and continues to increase: there have been at least 6.4 million flu-like illnesses, 55,000 hospitalisations and 2,900 deaths from flu. The predominant strain in the US has been Influenza B/Victoria, followed by A(H1N1)pdm09 viruses.

The northern hemisphere has been braced for a severe flu season following the severe season in Australia during their last winter, when more than 430 deaths were reported.

VACCINATION UPTAKE

Flu vaccination rates are below target for most groups: just 40% of people under 65 years in a clinical risk group had been vaccinated before the end of the year. For pregnant women, the figure was 41%. Uptake among the over-65s was higher, at 70%. There has been a small increase in the numbers of frontline healthcare workers – 61.5% had been vaccinated by the end of November, compared with 61% at the same point in 2018.

Provisional figures for children aged 2 and 3, due to be vaccinated in general practice were 32.5% and 31.7%, respectively, compared with around 40-45% for children in the schools vaccination programme. The children’s flu programme was affected by delays to delivery of some batches of the LAIV nasal vaccine, with schools having to reschedule plans to vaccinate children in November, but these have now been resolved. The primary school programme has resumed, and practices have sufficient stocks to vaccinate younger children.

Professor Yvonne Doyle, Medical Director and Director of Health Protection for Public Health England, said: ‘The flu vaccine remains the best defence we have against flu and protects those people who are most vulnerable. The main circulating strain of flu is well matched to this year’s vaccine.’

She urged members of the public: ‘It is not too late to get vaccinated. If you are eligible, get your vaccine from [your] GP or pharmacist to ensure you are protected.’