2009 swine flu pandemic in the United Kingdom

The 2009 swine flu pandemic was a global outbreak of a new strain of influenza A virus subtype H1N1, first identified in April 2009, termed Pandemic H1N1/09 virus by the World Health Organization and colloquially called swine flu. The outbreak was first observed in Mexico, and quickly spread globally. On 11 June 2009, the WHO declared the outbreak to be a pandemic. The overwhelming majority of patients experienced mild symptoms, but some persons were in higher risk groups, such as those with asthma, diabetes, obesity, heart disease, who were pregnant or had a weakened immune system. In the rare severe cases, around 3–5 days after symptoms manifest, the sufferer's condition declines quickly, often to the point of respiratory failure.
The virus reached the United Kingdom in April 2009. The first cases were confirmed on 27 April 2009 in passengers returning from Mexico. The first case of person to person transmission within the UK was announced on 1 May 2009. In the UK, 5- to 14-year-olds were the age group predominantly affected. Laboratory tests demonstrated that older people had some immunity.
After a slow start, the virus spread rapidly in the UK in July 2009, with new cases peaking at 110,000 in the last week of that month, according to The Health Protection Agency's modelling estimate, but declining sharply in the first week of August 2009. Cases fell progressively down to 3,000 in the first week of September 2009, then began to rise again. The decline in cases during the summer had been predicted, but a large surge was expected in the autumn to coincide with the normal flu season. Cases rose to 84,000 by the end of October, well below the summer's peak, and then declined during November.
Image:Swineflu uk hpa model.svg|thumb|341px|
UK 2009 Swine Flu cases per week.

''Health Protection Agency modelling''

Outbreak timeline

2009	UK swine flu outbreak, milestone
27 April	First two UK H1N1 cases confirmed in Scotland after a flight from Mexico.
29 April	Paignton Community and Sports College closes for about a week in first school closure.
1 May	First two UK person to person transmissions confirmed.
2 May	Further schools are temporarily closed from this date.
7 May	HPA issues advice on exclusion from schools and workplaces.
8 May	HPA issues "advice on actions to be taken in a school in the event of a probable or confirmed case of "swine flu" being identified in a school pupil", in which closure for 7 days is advised when appropriate.
8 May	The virus from European samples isolated and its full genetic fingerprint determined by UK researchers, following similar work in the US on the virus in the American continent.
17 May	One hundredth confirmed case.
22 May	HPA staff no longer routinely meet flights from Mexico. Contact tracing of passengers deemed to be at risk of swine flu carried out on the basis of risk, as for other communicable diseases.
26 May	The largest single outbreak so far, with 50 confirmed cases identified at a Birmingham primary school.
13 June	Over 1,000 cases of swine flu confirmed in the UK.
14 June	First death, of patient with underlying health problems, reported at the Royal Alexandra Hospital in Paisley, Glasgow, Scotland.
26 June	Second death, of patient with underlying health problems, of a six-year-old girl at Birmingham Children's Hospital in the West Midlands region. Her death was reported on 29 June.
30 June	6,000 cases of swine flu confirmed in the UK.
2 July	The HPA announced that the containment approach to reduce spread was no longer appropriate given the clusters of cases around the UK, and would be replaced by a treatment phase in which everybody presenting symptoms would be treated if necessary without laboratory confirmation, but contacts would not be traced. Daily reports of confirmed cases are no longer being published.
6 July	Three deaths in the UK bringing the total to seven. The new victims include two 9-year-old girls. NHS stated all three had "serious underlying health problems". The victims are from South London and Dewsbury in West Yorkshire.
9 July	The government announced that there are now over 9,000 cases of Swine flu in the UK and 14 patients have died, 2 in Scotland, 5 in London, and the remainder elsewhere in England.
10 July	A 15th person has died from swine flu in Essex. Unlike previous cases, they had no underlying health conditions.
13 July	2 more people die with swine flu in England. One, a 6-year-old girl, who died of septacemia, and a middle-aged doctor. Initial reports that he died of Pulmonary Embolism were disproved on his final Post Mortem, which concluded that Swine Flu was a contributing factor in his death.
16 July	It emerges that 12 more people have died. The total now stands at 29. 85,000 people are estimated to be affected by swine flu as of 16 July, with 55,000 new infections in the preceding week according to HPA modelling.
23 July	The National Pandemic Flu Service goes live in England for the first time. Shortly after it goes live, the Service gets over 2,000 hits per second. Scotland, Wales and Northern Ireland can opt in for the service if the rate of infection increases.
21 August	The first swine flu related death in Wales has been confirmed after a 55-year-old woman died.
15 October	Its announced that there were 27,000 new swine flu cases in the past week, up from 18,000 the week before, and new cases were rising more slowly than expected, but the number requiring treatment in intensive care had increased from 47 out of 290 hospitalised last week to 74 out of 364 hospitalised this week. The number of deaths in the UK rose to 106.
21 October	Swine Flu Vaccine became available across the UK and mass immunisation programme gets under way.
22 October	It's announced that Swine flu cases in the UK almost doubled from the previous week to 53,000. The number of patients needing hospital care has risen to 506 in England with 99 in critical care – the highest since the pandemic began. Deaths increased to 128. The total number of cases is now estimated to be 435,000.
29 October	Swine Flu cases rose by almost 50% to 78,000 new cases. Deaths increased to 137. Hospitalised patients increased to 751, of which 157 are in intensive care including nine people on ECMO machines. It is now estimated that there have been 521,000 cases in England since the pandemic began. It is also reported that one in three deaths are not in the "priority vaccination group" as currently defined by the government.
5 November	New Swine Flu cases increased to 84,000. Deaths increased to 154. 848 people are hospitalised, 172 of which are in intensive care. It is thought that the rise in new cases was smaller this week due to school children being on their "half term" holidays. Andrew Lansley, the Shadow Health Secretary, called on the Government to commit to vaccinating all schoolchildren in the country, as well as university students.
12 November	The number of new swine flu cases in the past week fell by nearly a quarter to 64,000 in England. Deaths increased to 182. Hospitalised patients fell to 785, of whom 173 are in intensive care. The Chief Medical Officer, Sir Liam Donaldson, said that the drop in new cases could be due to school children's half term break, the impact of which could last two weeks and that next week's figures should give a clearer picture of how the virus is developing. Shadow health secretary Andrew Lansley said the latest figures again illustrated the importance of vaccinating children. "This is further evidence that we need to begin planning a school and college-based vaccination programme immediately."
19 November	New Swine Flu cases decreased again from the previous week, down to 53,000 new cases in England in the last week. 783 patients were hospitalised. The number of deaths related to swine flu in the UK increased to 214. The HPA estimates that there have now been a total of 715,000 cases of swine flu since the pandemic began. The government has announced that all children under the age of five are to get the swine flu vaccine. Chief Medical Officer Sir Liam Donaldson said there had been a rise in serious illnesses recently among young children that was "causing concern". "We consider them to be seriously at risk". Latest figures showed that 81% of under-5s hospitalised with swine flu had no underlying health issues. The Conservative Party says that all under-25s should get the vaccine next.
20 November	The first officially confirmed cases of person-to-person transmission of a Tamiflu-resistant strain of swine flu in the world are reported to have happened between 5 patients at the University Hospital of Wales in Cardiff.
26 November	The number of new swine flu cases continue to fall, with 46,000 new cases in the last week, 7,000 less than the week before. However Swine flu deaths in England in a single week reached their highest level with a record 21 deaths, bringing the total deaths to 245 in the UK. There were 753 hospitalised patients, 154 of those being in intensive care. The Government estimates more than a million people have now been vaccinated, roughly a month after the vaccination program started. That means only about 1 in 10 of the 11 million people in the "at risk" priority groups have so far been vaccinated. Professor David Salisbury, head of immunisation at the Department of Health was disappointed, saying "Clearly I would have liked a bigger number...I would like to see an acceleration now".
3 December	New Swine Flu cases more than halved from the previous week, dropping to 22,000 new cases in England in the last week. Total deaths increased to 270. There are 747 hospitalised patients – 161 of which are in critical care. A further 600,000 people were vaccinated in the last week, bringing total to 1.6 million people. In addition to that, 275,000 healthcare workers have been vaccinated out of nearly 2 million. Chief Medical Officer Sir Liam Donaldson said it was still "too early" to know whether the downward trend in new cases would continue and that his biggest worry was the virus mutating or mixing with other viruses and creating a new, more dangerous virus. Prof David Salisbury, head of immunisation at the Department of Health, said the vaccines with adjuvants, substances which boost the immune system and allow less active ingredient to be used in each dose, offer good protection even if the virus does change; "One of the advantages with adjuvanted vaccines is their ability to protect against drifted strains. It opens the door for a whole new strategy in dealing with flu." The GlaxoSmithKline vaccine, Pandemrix, which forms the bulk of the governments mass vaccination programme with 11.2 million doses delivered so far to health services, contains an adjuvant.
10 December	New Swine Flu cases halved from the previous week, to 11,000 new cases in England. Deaths increased to 283 and there were currently 636 hospitalised patients. The number of people vaccinated increased to 2.3 million. The estimated total number of cases is 795,000. The Chief Medical Officer Sir Liam Donaldson revealed that the swine flu pandemic is "considerably less lethal" than feared. An analysis of deaths to 8 November showed that 26 people have died for every 100,000 cases in England, meaning a death rate of 0.026% in those infected with Swine Flu. The highest death rate was in those aged over 65, and lowest in those aged 5 to 14. The average age at death was 39. Of the patients who died, 67% were in the "high risk" vaccination priority group and were eligible to get vaccinated, 36% had either no or only mild pre-existing illnesses. Sir Liam again urged people to come forward for immunisation, commenting that a lower impact than previously feared "is not a justification for public health inaction. Our data supports the priority vaccination of high risk groups. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme".
17 December	New Swine Flu cases again fell with 9000 people infected in last week. Total deaths in the UK increased to 299. The number of currently hospitalised patients fell to 523 patients of which more than 100 were in intensive care. 3 million people out of the 9 million in the 1st vaccination priority groups have now been vaccinated including 100,000 pregnant women. In addition to that, 343,000 front line health workers have also been vaccinated. It appears that the second wave of Swine Flu is coming to an end but experts warn cases could rise again in the future in a "third wave" of swine flu.
24 December	New cases of Swine Flu fell by a third to 6,000 cases this week. The total death figures will be updated by the HPA on Thursday 7 January. The number of hospitalised patients declined to 454 currently in hospital.
31 December	The HPA did not release estimate numbers this week, instead saying that flu activity is continuing to decrease across the UK but some caution must be exercised as this may be influenced by the holiday period. 496 patients were currently hospitalised in England as of 8 am on 30 December. A more detailed update will be released next week.
8 January	Swine Flu cases continued to decrease, down to less than 5,000 new cases in the preceding week. Total UK deaths increased to 360. Hospitalised patients in England numbered 393, of whom 103 were in critical care. Only 3.2 million people had been vaccinated, including 113,000 pregnant women, 86,000 under-5s and an additional 373,000 front-line health workers. The Head of Immunisation at the Department of Health, Professor David Salisbury urged all those in the at-risk priority groups to get immunised, especially children under five and those with underlying health conditions, because while cases were currently down, it was not clear what would happen with swine flu over the year ahead.