P225 The post pandemic influenza experience in a busy district general hospital

Abstract

The 2009/2010 swine origin influenza virus (H1N1) pandemiccreated a national helpline, vaccination program and advertisingcampaign that cost many millions of pounds. There were a number ofdeaths in young pregnant people and those with existing respiratorymorbidity. In contrast, in the post pandemic we have seen budgetarycuts, no advertising campaign and a reluctance to give vaccination toanyone but clearly defined groups. Our experience during theDecember 2010 holiday period suggests this was ill advised.We analysed all admissions with H1N1 in December2010-January 2011. In total we had 63 cases in a take that has a meanof 27 (SEM +/-1.97) patients per day. Over 70% of patients presentedbetween 30th December and 2nd January. These patients were young(mean age 47 (SEM 1.81)), had an increased length of stay (mean LOS6.2 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(>38degreeC) 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, (Haemophilusinfluenzae) and all blood cultures were negative. Six were admitted toITU (9.6%, but 100% of ITU beds available) and 3 died (4.8%), all ofwhom had significant respiratory co-morbidity.Our small DGH experienced a significant number of extraadmissions over what is perhaps the busiest and least well staffedperiod the NHS has to deal with. These included a high number ofyoung, previously well patients who had significant illness andlengths of stay. At one point 100% of critical care and level 2 bedswere full of patients with H1N1. Vaccination would have preventedthis crisis and at a reasonable cost and is as important in the postpandemic year as during a pandemic. It should be freely available toall on an annual basis.