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Swine Flu and ITP

The ITP Support Association is grateful to Professor Adrian Newland for the following information and advice. Professor Newland, medical advisor to the ITP Support Association and internationally renowned ITP specialist, is Director of the Pathology Clinical Academic Unit at Barts and the London NHS Trust, London, UK.

What we know about swine flu
There is not a lot that we can specifically say about swine flu yet but there are many similarities to ‘ordinary’ flu that we can extrapolate from and we do have experience of previous pandemics. It is important that sensible precautions are taken, in particular regular hand washing, covering up for coughs, discarding tissues carefully and wiping contact surfaces regularly, and avoiding others who have a viral infection that could be swine flu.

We know from the yearly flu infections that even in normal people the infection can be serious (and very rarely fatal) but the vast majority have only a mild infection and fully recover. This is currently the case for swine flu. For these staying indoors, taking plenty of rest and fluid and paracetamol are adequate measures. Most recover within a week.

Who is at risk
People at serious risk from swine flu are, in particular, those with underlying medical problems, those with serious chest problems are especially vulnerable, as are also those on treatment with steroids or other immune-suppressants. A detailed list is on the NHS web-site. There is almost certainly no increased risk for patients who have had a previous splenectomy if they are off all other treatment.

ITP and swine flu
If a patient with ITP catches swine flu this may, like all infections, drop the platelet count and a look out should be made for any change in the pattern of bleeding or bruising. We have not seen this in the small number of patients we have been involved with although we have seen a suppression of the white cell count in some and in one a fall in haemoglobin. These may be seen in all viral infections. The more general change in the blood, however, is an increase in the white count as a normal reaction to infection.

What to do if you suspect you have swine flu
Tamiflu, if it is likely to help, should be given in the first 48 hours of the infection. It should be considered in any who are in a high risk group and have the signs of infection (high temperature, fatigue and debility, loss of appetite). If you consider that swine flu is a possibility stay indoors and either phone your GP or get someone to visit and pick up a prescription. Do not in these circumstances go out yourself and risk infecting others. There is no evidence that Tamiflu should adversely impact on the ITP.

Swine flu vaccine
The vaccine will not be available until the late summer/early autumn and will not be given widely until the New Year according to the Chief Medical Officer of England. This will not be a live vaccine and can be given to patients on steroids although in these the response may not be optimal.

GPs should be able to identify patients at risk but any patient who feels they are in this category should contact their GP as they may be very busy at this time (as many are now). The vaccine will be relatively new and will not have had extensive testing and it is worth remembering that in 1976, a vaccine rushed into distribution against a different type of swine flu in the United States caused high rates of Guillain-Barre syndrome, a rare and potentially paralysing neurological disorder. The risks and benefits need to be weighed up and discussed.

For further information on swine flu please visit the NHS website http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Symptoms.aspx.