Abstract

The 2009/2010 swine origin influenza virus (H1N1) pandemic created a national helpline, vaccination program and advertising campaign that cost many millions of pounds. There were a number of deaths in young pregnant people and those with existing respiratory morbidity. In contrast, in the post pandemic we have seen budgetary cuts, no advertising campaign and a reluctance to give vaccination to anyone but clearly defined groups. Our experience during the December 2010 holiday period suggests this was ill advised.

We analysed all admissions with H1N1 in December 2010–January 2011. In total we had 63 cases in a take that has a mean of 27 (SEM ±1.97) patients per day. Over 70% of patients presented between 30th December and 2nd January. These patients were young (mean age 47 (SEM 1.81)), had an increased length of stay (mean LOS 6.2 days (SEM 1.54)) and were from low risk populations (35/63 (56%) had no co-morbidities or risk factors). All had a significant fever (>38°C) and most had a successful recovery (95% discharged home). CXR was normal in the majority (78%), mean WCC was normal (8.83 (SEM 0.51)) but most were lymphopaenic (mean lymph 1.01 (SEM 0.09)). Only one had a positive sputum culture, (Haemophilus influenzae) and all blood cultures were negative. Six were admitted to ITU (9.6%, but 100% of ITU beds available) and 3 died (4.8%), all of whom had significant respiratory co-morbidity.

Our small DGH experienced a significant number of extra admissions over what is perhaps the busiest and least well staffed period the NHS has to deal with. These included a high number of young, previously well patients who had significant illness and lengths of stay. At one point 100% of critical care and level 2 beds were full of patients with H1N1. Vaccination would have prevented this crisis and at a reasonable cost and is as important in the post pandemic year as during a pandemic. It should be freely available to all on an annual basis.