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H1/N1 influenza update.

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Subject: H1/N1 influenza update

NICOLA ROXON: Thank you for coming today. I just wanted to provide you with a weekly update that we are doing now for the H1N1 pandemic.

We have publicly confirmed cases in Australia now of over 10,000; 10,387. Of course I need to remind you that that figure increasingly is less relevant. Now that we've moved to the PROTECT phase there isn't testing for every person who might have a mild case of H1N1 Influenza.

Increasingly we are looking to focus on the numbers of people of course who have been hospitalised and those who are having the most severe consequences from this disease.

Currently across the country there are at least 123 people hospitalised - that includes 32 people in New South Wales in intensive care units - but doesn't provide the broader number in New South Wales; we don't have that current data. We do have it for other jurisdictions if people need a particular update on that. We have 58 people across the country in intensive care units.

Obviously the information that we have provided before still seems to be being consistent and accurate information about the disease. Mostly the people who are being hospitalised are those with other underlying health conditions. We do see that there are some people that are young and otherwise healthy who have rapidly deteriorating disease. And of course we are focusing our attention and making sure that we can identify those with underlying conditions that might be likely to experience this disease in the severest form or those with a rapidly deteriorating disease.

What we are doing here in Australia is consistent with what the World Health Organization is now advising other countries around the world to do, which is to focus their attention on identifying those people.

Out of all of the cases that we have identified here in Australia, 698 of those have been identified as Indigenous Australians. They represent about seven per cent of cases to date. But of course you'd be aware make up just under 2.5 per cent of the population.

The rate for Indigenous Australians of hospitalisations is also slightly higher. And of course this is not a surprise given our awareness that those who are particularly at risk are those with chronic diseases and that many Indigenous Australians have those underlying chronic diseases.

The influenza surveillance material that is provided from a range of sources - from hospitals, from general practice clinics, from the standing surveillance systems that are in place each year for flu - are giving us an updated national picture of this disease and the nature and impact of the pandemic strain of H1N1. And, as I say, this information is collated from doctors, laboratories, emergency departments, hospitals and public health units in state and territory health departments.

What this information from the surveillance is showing us, that the spread of the disease is consistent with expectations: of course that the number of cases would increase; that the disease would remain mild in most people; that not all cases will be identified, as testing is moving to focus on those with severe illness.

Nationally the proportion of positive influenza tests which were pandemic H1N1 has now increased to 70 per cent for the week ending 27 June - of course there's some delay in the collation of this data - an increase from when I reported to you last week that the national figures were 64 per cent at the end of the week June 20. So this is the following week's update. The numbers are expected to peak in August.

The proportion varies from state to state. We're at 75 per cent, for example, in Western Australia; 71 in the Northern Territory; 51 in New South Wales; and 99 per cent in Victoria.

And, as I indicated at that time, that information from Victoria is showing us that the pandemic strain of flu is becoming the dominant strain of flu in Australia this winter.

Patients with flu-like illnesses are also presenting at GPs at a rate of about 25 cases for every 1000 patients seen, which is higher than that in the flu season in 2008 but similar to the rates in 2007, which was the highest influenza season we experienced in recent years.

The median age of confirmed cases is still at 19. We think this age might increase as the testing focus changes to the severely affected and those that are hospitalised rather than of course the early testing which was focused very much

around secondary schools. And males and females appear to be at similar risk of infection.

Let me just give you an update on two more issues, then I'll open it up to questions.

Beyond the general statistics about the broad spread of the virus there's also, as I've indicated, this very small group of young people without risk factors whose health has rapidly deteriorated after infection with the pandemic strain of H1N1.

The Chief Medical Officer advised that this small number of cases has also been observed overseas, and that clinical evidence indicated it was important for us to catch these people early and treat them before they had life threatening diseases. This is why Professor Bishop convened his advisory group to provide the best information about ways to identify and treat this particular group of people.

So the clinical specialists advisory group has now provided the resource document to GPs and other medical professionals to help them identify and treat those who might deteriorate quickly.

I'm advised by Professor Bishop that the early signs that people should look for is really the troubled breathing very early in the disease, and it's possible for people to deteriorate quite quickly over a couple of days.

The advice provided to the health professionals assist them to make early decisions whether to transfer patients to hospitals or other facilities. And while of course this new development is concerning and needs to be carefully monitored, it's important to remember that the disease does remain mild in most cases, severe in some, and moderate overall.

Finally, let me give you an update on the vaccine issues, although note that Professor Bishop did make some comments particularly about this yesterday.

Next week CSL's human trials for the vaccine are going to commence to ensure its safety and efficacy. The results from the clinical trials would start to be available in September and would be carefully examined by the Therapeutic Goods Administration before the vaccine is authorised for distribution. Subject to these checks, the vaccine is likely to be available in October, but of course that does depend on the test being successful.

As previously announced, we've placed an order for this vaccine. It means Australians will be amongst the first in the world to be vaccinated for the disease.

We've ordered 21 million doses which will be enough to vaccinate half of our population if two doses are required, or the entire population if one dose is

required. That does depend on the human trials that are being conducted to see how many doses are required for it be effective. The dose is going to be informed by that - those clinical trials.

The distribution of the vaccine will be based on medical advice. The preliminary advice that we have - bearing in mind that if we get new information about the disease this could be modified - is that those most at risk of the severe effects from the disease, such as the people with chronic conditions we've been talking about since very early on in this pandemic, and groups likely to facilitate the rapid spread of the disease, such as school-age children, would be prioritised.

So I'm happy to answer questions that you might have, but hopefully that gives you a bit of an update.

QUESTION: Is it a worry that under the current regime will it - that we're not immediately testing people who may be in that young and fit high-risk group that are experiencing rapid decline?

NICOLA ROXON: What I think we need to remember is that it's a very small number of people who may experience that rapid deterioration, and I think it would be not using our resources widely - wisely to test everyone, a vast range of people and a vast range of resources, in the hope that that would help us identify those who are most at risk.

In fact, we need to use clinical indicators to find out who is most likely experiencing negative consequences. It does mean we have to act quickly when we see those people and it is a difficult situation for our health professions.

But I'm very confident that armed with this information they are absolutely up to the task, and I want them to be obviously being able to concentrate their efforts on those who are presenting with these - at - in at-risk categories or likely to deteriorate quickly, rather than us spreading their efforts too thinly across the broader population when we know that the vast majority of people will have very mild symptoms.

QUESTION: Health authorities in the UK are fast-tracking their vaccine. Is there any way that we could fast-track the development and the distribution of the vaccine in Australia?

NICOLA ROXON: Well, we certainly are doing all we can to make sure that a safe and effective vaccine is available. We do believe it's appropriate to conduct these human clinical trials. Obviously decisions that are made by other countries you would really need to address those questions to them. We will look closely at what is happening overseas.

I think the key issue for us is to make sure that we know the vaccine is safe and to balance that with the likely impact that people are experiencing from the disease. It is still a changing situation and if circumstances change, or our medical advice changes, the Government certainly stands ready to act on that.

QUESTION: Those young, otherwise healthy people that are getting it, I mean, what's going on there, Minister? Are these the disease coming back stronger? And how much of a concern?

NICOLA ROXON: Well look, it's obviously concerning. As we, I think, flagged fairly early on in this disease, we were concerned that it wasn't the same as other flus; that it seemed to be a disease that particularly preferred young people. There's all sorts of speculation about whether those over 50 have some sort of immunity from earlier flus of previous generations. We simply don't know the answers to that yet.

Anybody would be worried that there are otherwise healthy young people who might be afflicted severely by this disease. But our whole strategy has been to make sure our resources can be targeted to identifying those people and being able to act quickly to treat them.

We have a world-class health system that can do that. It certainly puts the health system under some strain, but I am confident that we are in a good position to tackle it. And I want our resources to be targeted to those who are most at risk, rather than us put a lot of effort into the vast majority of the community who will have pretty mild symptoms and recover without that medical intervention.

QUESTION: Out of the 123 people that are hospitalised, do you know how many are from that high-risk group or how many have underlying health conditions?

NICOLA ROXON: Look, I don't have an exact breakdown of that. I can tell you that of the 123 that are hospitalised, 58 are in intensive care. So obviously that shows you that, you know, nearly a third of the people that are hospitalised are in relatively severe situations.

The overwhelming majority, as I'm advised from my state and territory colleagues, have been people with underlying conditions. Remember that many of these chronic diseases do affect 20 and 30 per cent of the population, so they are still relatively common, a number of these diseases.

And what - as we learn more about it, we can try to identify what might be early signs or warning bells for health professionals to identify that someone needs extra treatment, that they need it quickly, that they might need to be moved to a different setting.

QUESTION: You said it was likely to peak in August, the number of infected cases is likely to peak in August. How high will it be, based on projections, when it peaks?

NICOLA ROXON: I can't answer that question. The expected peak is in August.

The medical professionals and the Chief Medical Officer who did a press conference yesterday to answer some of these questions has indicated the advice that we also provided when we went to the PROTECT phase, that if we don't mitigate its consequences, that we think 40,000 to 80,000 people could be hospitalised over the course of the winter. But that's if no other mitigation was taken. And we know of course that we have antivirals, that we are intervening. We hope, of course, that at some point in the future we will have a vaccine which might also reduce those numbers.

So that's the modelling if no action was taken. Of course we are taking a lot of action and we believe that can be significantly reduced.

QUESTION: There's been a prediction that more than 10,000 people could potentially die from swine flu; that's been rejected by the chief health officer. Do you agree with his position on that?

NICOLA ROXON: Certainly. We take our advice from the experts.

I think that some of the projections that are being bandied about in the media are based on modelling that has been done in the absence of any information about the particular disease that we're talking about.

When we moved to the PROTECT phase, we said that an unmitigated expected fatality rate was about 6000 across the country.

And we've seen some fairly ambitious, if not ludicrous claims being made that it might be 10,000 or 20,000 or 30,000 in particular states.

So, we can only go on the medical advice that we have. I'm confident that it's based on very sensible modelling that takes account of the type of disease that we're talking about. And those figures were released nearly a month ago now.

When we say the fatality rate, if no health interventions were taken it's about 6000.

QUESTION: Just really quickly, when the order was made for 21 million vaccines, was the Government aware that there may be a need to double-dose people?

NICOLA ROXON: Absolutely. We made it on the advice that it was wise for us to be able to vaccinate up to half of the population. Generally the advice about the proportion of the community that needs to be vaccinated to stop its spread is about 30 per cent, and of course you want to be able to target people who are particularly at risk of severe outcomes.

So our expectation when the order was placed is that it would be half of the population that we would be covering. If it turns out the vaccine is effective with one dose it will mean that we are in even better placed. But we didn't place the order expecting that it would cover the entire population. We took advice that covering up to half of the population and particularly being able to target those most at risk was a sensible thing for us to do, and that's the basis upon which we placed the order.