The first flu pandemic of the 21st century is less lethal than experts feared, killing only 26 out of every 100,000 people who became ill, a study by the chief medical officer for England and Wales said on Thursday.
But a third of deaths have been among healthy people who would not have been eligible for vaccination under the present strategy. The medical officer, Liam Donaldson, and colleagues say in their paper published online that vaccination may have to be extended to a wider population than at present.
An estimated 540,000 people have gone down with swine flu in England since a pandemic was declared in July and there have been 138 deaths where flu was confirmed as the cause.
In spite of the concern for children and young people, there has been a particularly high fatality rate in the oldest age group, just as there was in previous pandemics. The over-65s are less likely to get flu, the results show, probably because they have been exposed to other H1N1 viruses in the past, but if they get it, they are at greater risk than most.
“The 1918-19 pandemic was characterized by high case fatality rates among young healthy adults. There is no evidence of this from our analysis of the current pandemic,” the paper says. “Our estimate of the case fatality rate compares favorably with those in the three 20th century influenza pandemics. The rate in the 1918-19 H1N1 pandemic was 2%-3%. Rates in the subsequent pandemics (1957-58 and 1967-68) were in the order of 0.2%.”
The case fatality rate in the current pandemic is 0.026 percent.
There are many different reasons for this, the study says. Estimates in the past will have been less accurate than they are today and people may have died from other circulating viruses as well as flu. Improvements in the food people eat, their housing and healthcare may also make a difference to survival these days. Modern intensive care treatment is a big factor.
“Many more patients might have died in England without the ready availability of critical care support, including mechanical ventilation,” it says.
Two thirds of those who died (67 percent) would have been eligible for vaccination if it had been available, the authors say, because of their age or a health problem such as asthma, but that leaves a third who would not have been vaccinated.
“Our findings ... show that a substantial minority of deaths are occurring outside [high risk] groups. Wider population vaccination therefore merits consideration,” the report says.
Most who died (78 percent) were given antiviral drugs (mainly Tamiflu), but only a quarter got them within the necessary 48 hours after symptoms appear.
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