Scotland: Swine flu testing criteria expanded as virus spreads

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Source: http://www.pulsetoday.co.uk/story.as...de=4122910&c=2

Swine flu testing criteria expanded as virus spreads

04 Jun 09

By Steve Nowottny

GPs in some parts of Scotland have been told to assess patients displaying flu-like symptoms as possible cases of swine flu - even if they are not a contact of a previous case and have no history of foreign travel.

The significant expansion of those considered at risk, outlined in the latest algorithm from Health Protection Scotland, comes amid growing signs that the virus is spreading.

The Health Protection Agency today confirmed a further 23 cases of swine flu in England, bringing the UK total to 428. And in its latest update to members, the RCGP warned it was ?highly probable? that a full pandemic would be declared ?some time soon.?

But it is a growing cluster of cases in Scotland, centred around the south of Glasgow, Paisley and Argyll & Bute, which is causing the most concern.
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The updated Health Protection Scotland algorithm warns GPs in those areas to consider all patients presenting with flu-like symptoms as potential cases, and says nose and throat swab samples should be taken.

A spokeswoman for Health Protection Scotland said: ?The algorithm has been regularly amended to reflect the changing situation in the country. The most recent changes concern the testing and infection control procedures related to cases of severe respiratory disease. These are related to the number of cases now hospitalised and echo the guidance given in a recent letter from the CMO.?

?In addition, we have strengthened guidance on the taking of samples from those presenting with influenza like illness who are in areas where cases have arisen who so far have not been linked to any previously known case or to a returning traveller.?

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Re: Scotland: Swine flu testing criteria expanded as virus spreads

Source: http://www.theherald.co.uk/news/news...s_hotspots.php

GPs to test patients for swine flu in three Scots hotspots
ALISON CAMPSIE June 05 2009

GPs are to carry out widespread swine flu testing of patients in three hotspots where the infection appears to be taking hold in Scotland, signifying a dramatic shift in the fight against the outbreak.

The Herald has learned that new advice to family doctors, quietly changed in the past two days, recommends that all patients with severe flu-like symptoms and who live in the three areas affected by serious cluster outbreaks - Argyll & Bute, Paisley and south Glasgow - should be tested as a matter of course.

The move is in response to the gathering pace of the disease, with another huge leap of 31 new confirmed infections yesterday marking a near-doubling of cases north of the border in the past 48 hours alone.
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Cases of swine flu are expected to accelerate as the strategy of containing the outbreak shifts to one of widespread testing or "coping", which will inevitably uncover greater numbers of infected people.

Before, the test was only offered to such patients who had been in contact with another carrier or who had recently travelled abroad, leading to concerns that some cases were going unreported.

Priority test areas have now been created in Argyll and Bute - which covers Dunoon where more than 60 people are now infected - Paisley and south Glasgow in a bid to handle the spread of the virus.

Last night, Health Secretary Nicola Sturgeon reported that the number of confirmed cases of swine flu in Scotland was now 119.

In comparison, England, which has 11 times the population of Scotland, has just 2.6 times the level of swine flu infection with 317 confirmed cases.

Professor Hugh Pennington, emeritus professor of bacteriology at the University of Aberdeen, said that the original approach to handling the outbreak was "too restrictive" and welcomed the change in the way GPs assessed patients for the H1N1 virus.

He said: "It means that we have pulled back from the policy of containment where you aggressively pursue each case and target those who have come into contact with other cases. Clearly that policy is too restrictive and this change addresses that.

"They don't want a mad rush of tests from Shetland to Stranraer, and I don't know if the system would cope with that, but what they have to do is create a balance that doesn't test the system beyond its limit but on the other hand gives a good clinical service to those living in such places where there have been clusters, such as Greenock and Dunoon."

He added: "I think it is fair to assume that you will now get a greater number of cases. Once the virus has shown that it cannot be contained you have to move to treat patients as they appear."

None of the new cases reported yesterday are travel-related and 21 of them are in the NHS Highland area, which covers Dunoon. A 23-month-old toddler from Lothian has also been diagnosed, but is not in a serious condition.

Three people remain in intensive care at the Royal Alexandra Hospital in Paisley where a 44-year-old woman is also being treated in the high dependency unit.

The condition of a 37-year-old man critically ill in Glasgow's Victoria Infirmary has now improved. Another 56 possible cases under investigation. Under further alterations to the Health Protection Scotland guidelines for diagnosis, all those in Scotland who are aged under 50 with pneumonia or another acute severe respiratory disease will be tested for swine flu.

Health Protection Scotland said last night that the new recommendations had "cascaded" down to public health boards, but no information could be given as to whether surgeries were expected to open longer, or if extra stocks of the anti-viral Tamiflu was required.

Dr Ken Lawton, chairman of the Royal College of GPs, said that GPs were "switched on" to the threat of swine flu.

"These new guidelines will mean more people being tested but it will help to differentiate between normal flu and those who have swine flu.

Ms Sturgeon said that the outbreak in the Argyll and Bute area had led to the closure of Kirn Primary and Inellan Primary in Cowal for seven days, following the diagnosis of three primary seven pupils who attended a school trip together. All 70 pupils and 20 staff who attended the event will all be offered Tamiflu, as will 230 pupils in the third year at Paisley Grammar School.

"We have always said that we expected to see an increase in cases in Scotland," Ms Sturgeon said last night.