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Pandemic Influenza H1N1 2009 (swine flu) – Update 196
Ministry of Health
Thursday 22 July 2010, 4:56pm

Media release from the Ministry of Health

Increasing influenza activity

Influenza activity continues to increase. In some areas of New Zealand - and as is often the case during winter - both GPs and hospitals are becoming increasingly busy with visits for influenza-like illness and other respiratory illness.

*A weekly rate of <50 ILI consultations per 100,000 patient population is considered baseline activity. A rate of 50-249 is considered indicative of normal seasonal influenza activity, and a rate of 250-399 indicative of higher than expected influenza activity. A rate of >400 ILI consultations per 100,000 patient population indicates an epidemic level of influenza activity.

Spring temperatures may have arrived early this year but people still need to be wary of illnesses that have pushed hospitals close to capacity.

Weather analyst Philip Duncan said the weather pattern for the past week had shifted into what looked more like spring than winter with daily highs reaching up to 18C in some parts of the country.

The coldest weather was typically six weeks after the shortest day (June 21) but many parts of the country had had temperatures normally seen in spring.

"I think we are in for an early spring this year," said Mr Duncan.

However, despite the increase in temperatures many hospitals are close to capacity as the number of people with colds and flus starts to increase.

In the Auckland region, laboratory notifications show a sharp increase in influenza cases over the past month, particularly in the past two weeks.

Dr Cathy Pikholz, Medical Officer of Health for the Auckland Regional Public Health Service, said a lot more people were out there with flu who had not been seen.

"We know these notifications are just the tip of the iceberg," she said.

"We strongly encourage people to get vaccinated especially women who are pregnant, very young children, severely overweight people and those with underlying medical conditions."

While the exact numbers of flu-stricken people was not available last night, many of Auckland's hospitals report busy periods believed to be linked to winter illnesses.

Auckland District Health Board spokesman Mark Fenwick said Auckland City and Starship hospitals had both been "pretty full" during the past week.

However, thanks to a winter plan and extra beds being freed up in other areas, there were about 70 more beds than in previous years so the hospital was not having to turn anyone away.

"We are flat out but we are coping."

Mr Fenwick said the hospitals were seeing many people with cold and flu symptoms and urged sick people to see their GP before going to hospital.

Counties Manukau District Health Board spokeswoman Lauren Young said Middlemore Hospital reached capacity on Wednesday, with around 30 people waiting for theatres and up to 300 needing emergency care.

"Our staff are doing an amazing job under immense pressure."

A lot of the patients had influenza and Ms Young said it was not toolate for people to get the flujab, which she strongly advised.

Waitemata District Health Board spokesman Paul Patton said North Shore Hospital had started out quietly at the weekend but had become very busy yesterday. It was expected to be close to capacity last night.

He said many the patients were coming in with "winter-type infections", something that was also affecting many staff.

The Ministry of Health's latest influenza update says cases are increasing around the country.

However, despite cases being on the rise, the overall picture showed fewer cases than in the previous two years.

Troy Wilson thought his 6-year-old daughter Chloe's sore throat was nothing more than a tickle.

That was at 4.30am last Monday. Just a few hours later, though, she was bright red in one cheek, had a temperature that was sky-rocketing and was not her usual self.

Chloe and then her sister Abby, 1, were soon added to the growing number of people who have caught the H1N1 flu strain, known as swine flu.

"Those first 24 hours were the most concerning part," Mr Wilson said.

"Our first thought was to put her in complete isolation. Then with her high temperature we had about half-a-dozen tepid baths and showers."

Chloe was the first to be hit. Instead of going back to school after the two-week break, she was taken to her grandmother's for the day. But as the morning progressed she worsened and was taken to Lakes PrimeCare and then to Lakeland Clinical Trial on Haupapa St where she was diagnosed with the pandemic strain.

Mr Wilson said he was called to give permission for her to go on pre-mixed Tamiflu and to take Chloe home.

"If you've got sick kids, get them treated," Mr Wilson said. "That's the role of being a parent.

"I was blown away when they said it was swine flu."

Soon after Chloe's diagnosis, Abby started showing the same symptoms - coughing, purple spots and high temperatures - but because of her age she couldn't undergo the same trial process that Chloe went through.

Instead the two girls were prescribed Tamiflu, and Mr Wilson and his wife Erin were also prescribed it as a precaution.

Mr Wilson said while he could cope with the constant battle of bringing their temperatures down, neither he nor his wife expected the nausea brought on by the medication.

"It made me sick and I had to have a white bowl next to me," Chloe said.

"It was sicky medicine."

Mr Wilson said there was nothing on the box to say it would make either children very nauseous and he felt terrible at having to make them take it.

After five doses they were deemed to be no longer contagious.

He had his flu jab a few months ago as his work for Event Promotions brings him into contact with thousands of people.

His mum, who looked after Chloe that first morning, had also had hers and was told she had not picked up the infection.

Lakes District Health Board communications manager Sue Wilkie said there had been five confirmed cases of H1N1 in the region so far this year but because this was the prevalent flu strain this year there were likely to be many more cases in the community.

"Rotorua Hospital has had several H1N1 cases in recent times this year," she said.

"It is important to stress that this is what we would be expecting, with overall influenza activity on a gradual rise, and at the level usually expected at this time of the year."
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The death of a Wellington woman from a brain virus after contracting swine flu should have been referred to the coroner, a finding released today says.

Hutt Hospital nurse Mony Heng, 39, died in Wellington Hospital on July 27 last year, 10 days after being admitted to the intensive care ward with breathing problems.

During her time in hospital, Ms Heng was sedated, put on a ventilator to help her breathe, given swine flu drug Tamiflu, antibiotics for other possible infections and medication for low blood pressure.

She remained critically ill but stable until July 25, when she had a very high fever and significant fluid retention, and was placed on a dialysis machine.

That night, she was found to have a dilated and unresponsive right pupil and was taken for an urgent CT scan which showed several parts of her brain had died due to a lack of blood supply.

Her family was given a prognosis of likely fatal brain damage, and on July 27, after a blessing by Buddhist monks, her treatment was withdrawn.

She died about midday on July 27, leaving behind her long-term partner and their six-year-old son.

A medical certificate from the hospital gave the cause of death as encephalitis of viral origin, following H1N1 (swine flu) pneumonia.

The hospital discussed her case with public health officials but not with the coroner because it was a one-off event -- despite 72 people having already been hospitalised nationwide with swine flu.

Coroner Ian Smith said there was no question the matter should have been reported to the coroner, because the Coroners Act required all deaths that occurred during medical treatment to be reported.

The hospital had filled out a coronial notification form, and had attempted to contact the chief coroner on July 28, but there was no knowledge of any call being received, Mr Smith said.

Ms Heng's death should also have been reported due to the public interest about the swine flu pandemic and "the wider aspect of medical knowledge", to reduce the chances of future deaths in similar circumstances.

The Chief Coroner, Capital and Coast chief medical officer and Ministry of Health later reached an understanding on reporting "all such deaths" to the coroner, Mr Smith said.

Mr Smith concurred with the hospital's finding of Ms Heng's cause of death.

Health authorities in Northland have reported the first ever suspected swine flu death in the region.

They say a 51-year-old man, who died suddenly earlier in July, was found to have the H1N1 virus. His death has been referred to the coroner.

Medical Officer of Health Jonathan Jarman says the man had an underlying health condition.

Dr Jarman says he has been asked about the safety of open casket tangi practices in deaths associated with H1N1 virus.

Dr Jarman says the virus does not survive long after a person's death and there is no reason why mourners should not touch or hold the body, or tupapaku, as long as they wash their hands afterwards.

He says the risk of influenza in large group settings, such as tangi, is catching the virus from someone else.

There have been only two confirmed cases of swine flu in Northland to date.

Swine flu has become the dominant flu virus in New Zealand and some emergency departments are struggling to cope.

Hospital admissions for winter illnesses hit a high for the year last week, although numbers were well down compared to last year's outbreak.

Almost 1900 people visited hospitals in the week with flu-like symptoms.

One emergency department estimates up to two-thirds of patients have been given Tamiflu or its generic equivalent, oseltamivir.

Many Auckland schools reported about one child per class had been sick each day, and the city's hospitals said they were running near capacity.

In Northland, Whangarei emergency department clinical leader Scott Cameron said his team was overloaded: "It's very uncomfortable for us in terms of staffing and space."

Last year, many people with the flu were kept away from hospitals. But this year, people with flu-like symptoms have flooded emergency departments - and staff numbers are down with many having caught the flu themselves.

Waikato Hospital clinical microbiologist Chris Mansell said swine flu was currently the only influenza strain circulating New Zealand.

Dr Mansell's laboratory tests for patients in Waikato and the Bay of Plenty have found up to one in 10 patients with a winter illness had influenza, with only swine flu detected.

The Ministry of Health said tests showed swine flu was the predominant strain this year.

Swine flu is the year's biggest threat among winter illnesses, but it is already well established and therefore less likely to explode.

The Ministry of Health estimates more than a million New Zealanders - almost a third of the country - have been exposed to swine flu and have become immune to the strain, including those who received a vaccine.

People visiting hospitals with the flu were likely just a hundredth of the total with swine flu, Dr Mansell said.

People who are overweight or pregnant, smoke or have lung conditions could face complications.

Pregnant women with flu-like symptoms had a high chance of contracting a severe disease and were strongly urged to get immediate advice from their doctor, Dr Jarman said.

Dr Mansell said his Waikato laboratory was running at about 80 per cent capacity, and Ministry of Health figures show consultations are down as much as six-fold from last year.

But influenza usually spikes with a sudden upsurge spanning about two weeks, and this could still be coming.

Fifty-nine people were admitted to hospital with swine flu last week, bringing the total to 159. Two people have died from the virus this year.

Non-influenza viruses circulating New Zealand include rhinovirus and respiratory syncytial virus, which is highly contagious and demands isolation at hospitals.

FLU UPDATE
* Almost 100 per cent of the country's influenza is now swine flu.
* Two in three patients with flu symptoms are given Tamiflu.
* One in three Kiwis have been exposed to swine flu.

North island now "High" flu activity according to Google Flu Trends.