Swine flu pregnancy tips reissued

A suppressed immune system makes pregnant women more vulnerable

The Department of Health has attempted to clarify its guidelines to expectant mothers and parents with children under five on how best to avoid swine flu.

Its advice to practise good hygiene by washing hands and surfaces regularly has been re-issued after a woman with the virus died soon after giving birth.

The Royal College of Midwives (RCM) says all expectant mothers should avoid crowded places and unnecessary travel.

But the DoH says only the “particularly concerned” should consider the advice.

Concern over the effects of swine flu on new and expectant mothers has heightened since the death of Ruptara Miah, 39, in London’s Whipps Cross Hospital on 13 July. Her baby is said to be very ill in intensive care.

Good hygiene

Another child under six months old, who died in London, is also among the latest victims of the virus.

The refreshed DoH advice has been given greater prominence on its website.

Health experts say expectant mothers could suffer possible complications if they contract swine flu, such as pneumonia, breathing difficulties and dehydration, because they have suppressed immune systems. Young children are also vulnerable.

Most mothers-to-be with swine flu are being prescribed Relenza, an inhaled antiviral drug which treats the virus without reaching the foetus. However, where it is particularly severe, doctors can offer Tamiflu instead.

The NHS website stresses that most expectant mothers who contract swine flu will only have mild symptoms and recover within a week.

Belinda Phipps, chief executive of the National Childbirth Trust (NCT), said that while the risks for expectant mothers were low, women needed information to make an informed decision.

“If you are pregnant, you are slightly more susceptible to all infections. One of them is swine flu.

“It is important that pregnant women know that – and particularly other members of the population know that – so that they behave responsibly and if they are sick they don’t go and put themselves close to a pregnant woman.”

If you are pregnant, you are slightly more susceptible to all infections. One of them is swine flu Belinda Phipps, NCT

The Department of Health said it advised women to plan their pregnancy carefully, but was not advising against trying to conceive.

“Mums-to-be are more vulnerable to any type of flu. It is particularly important that anyone who has existing health problems and is thinking about starting a family should talk to their GP first, as they normally would,” a DoH spokesman said.

Louise Silverton, deputy general secretary of the RCM, said women could not be expected to wait for the first wave of the pandemic to end before trying for a baby.

Speaking on BBC One’s Andrew Marr Show, Alan Johnson, the new home secretary, said an unexpected aspect of the virus was that it was attacking the young, not the elderly as with seasonal flu.

He called on parents to keep using their common sense, saying the “vast majority” had been following public health advice.

Twenty-nine people have now died in the UK after contracting swine flu – 26 in England and three in Scotland.

The government has warned that the number of deaths from the virus this winter in the UK could reach between 19,000 and 65,000.

However, during the 1999 to 2000 winter, seasonal flu deaths reached 21,000 and even during average winters there are normally anywhere between 6,000 to 8,000 deaths.

The National Flu Service will go live at the end of next week

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We asked you whether you were concerned about the effects swine flu might have on expectant mothers. Here is a selection of your comments.

I am in the third trimester of pregnancy, and I am asthmatic. I am concerned that neither Tamiflu or Relenza will be suitable for me if I contract swine flu.
Louise, Nottingham

This is such stupid advice. I am pregnant and travel to work every day on a packed Tube. How am I supposed to avoid crowded places and unnecessary travel? It’s impossible. I can’t just stop going to work can I?
Laura, Hertfordshire

My daughter has a 4yr old son who has swine flu, she is 4 months pregnant and worried in case she catches it and it harms the baby, we are also worried about the treatments used in pregnant women. There is to much contradiction going around to know what to believe.
Tina, Essex

I am currently 24 weeks pregnant and have been ill and at home for 5 days now with bad cold symptoms. After consulting the doctor by phone I was told it could possibly be swine flu but how am I to know? I am usually very level headed in these situations but not sure that not swabbing pregnant women with symptoms is wise – at least if we know if we have it we can be better informed!
Anonymous, Wales

I am 36 weeks pregnant and came into contact with Swine flu last week. I experienced a slight sore throat spoke with a nurse at NHS direct and my GP and was completely reassured that I was fine and not displaying any symptoms. There is definitely some scaremongering going on but if you seek appropriate medical advice your fears can be eased.
Jo, Romford, Essex

I have got a 14 month old child and am currently pregnant. I’m very worried we could all catch the virus as a lot of people where we live are getting it. Also it is going round schools where my niece goes. I believe there should be vaccinations soon as possible for young children and those who it could endanger more than others
Nikki, Chelmsford, Essex

Antibiotic ‘cerebral palsy link’

Antibiotics appeared to treble the risk of cerebral palsy

A study has linked a small number of cases of cerebral palsy to antibiotics given to women in premature labor.

The UK study found 35 cases of cerebral palsy in 769 children of women without early broken waters given antibiotics.

This compared with 12 cases among 735 children of women not given the drugs. Advice is being sent to the study’s 4,148 mothers and a helpline set up.

Medical experts stressed pregnant women should not feel concerned about taking antibiotics to treat infections.

These findings do not mean that antibiotics are unsafe for use in pregnancy The Royal College of Obstetricians and Gynaecologists

The Oracle study was the largest trial in the world into premature labor and was set up to investigate whether giving antibiotics – which might tackle an underlying symptomless infection – to women with signs of premature labor would improve outcomes for babies.

One in eight babies in the UK is born prematurely and prematurity is the leading cause of disability and of infant death in the first month after birth.

Premature labor

In 2001, ORACLE found the antibiotic erythromycin had immediate benefits for women in premature labor (before 37 weeks gestation) whose waters had broken. It delayed onset of labor and reduced the risk of infections and breathing problems in babies.

Erythromycin and the other antibiotic studied – co-amoxiclav – showed no benefit or harm for the women whose waters were still intact, however, and doctors were advised not to routinely prescribe them in such circumstances.

To study the longer-term outcomes, the Medical Research Council-funded scientists followed up the children seven years later.

Pregnant women should not feel concerned about taking antibiotics to treat infections Chief Medical Officer Sir Liam Donaldson

Unexpectedly, both antibiotics appeared to increase the risk of functional impairment – such as difficulty walking or problems with day to day problem solving – and treble the chance of cerebral palsy in the children of the women whose waters had not broken.

Of the 769 children born to mothers without early broken waters and given both antibiotics, 35 had cerebral palsy, compared with 12 out of 735 whose mothers did not receive antibiotics in the same circumstances.

The reasons behind this link are unclear, particularly as there was no increased risk of cerebral palsy in women whose waters had broken.

Hostile environment

The researchers believe cerebral palsy is unlikely to be a direct effect of the antibiotic but rather due to factors involved in prolonging a pregnancy that might otherwise have delivered early.

Researcher Professor Peter Brocklehurst of Oxford University said: “We have a suspicion that infection is implicated in premature labour.

“Antibiotics may merely suppress levels of infection to stop preterm labour, but the baby remains in a hostile environment.”

Infections during pregnancy or infancy are known to cause cerebral palsy.

In a letter to doctors and midwives advising them about the findings, Chief Medical Officer Sir Liam Donaldson says: “Pregnant women should not feel concerned about taking antibiotics to treat infections.

“It is important to note that these women had no evidence of infection and would not routinely be given antibiotics.”

Where there is obvious infection, antibiotics can be life-saving for both mother and baby, the CMO says.

The Royal College of Obstetricians and Gynaecologists said: “These findings do not mean that antibiotics are unsafe for use in pregnancy. Pregnant women showing signs of infection should be treated promptly with antibiotics.”

Cerebral palsy can cause physical impairments and mobility problems.

It results from the failure of a part of the brain to develop before birth or in early childhood or brain damage and affects one in 400 births.

A helpline is available for study participants on 0800 085 2411 between 0930 and 1630 BST. NHS Direct has information available for other members of the public.

A spokeswoman from the special care baby charity Bliss said: “This highlights the importance of fully understanding both the immediate and long-term impact of the care and treatment that both mother and baby receive at this crucial time.”

Antibiotic resistance rise fears

The NHS is being warned about its use of antibiotics

The rise in antibiotic resistance is reaching worrying levels, experts say.

The Health Protection Agency said while the focus on infections such as MRSA had been largely successful, new trends in other bugs were now posing a threat.

For instance, 12% of bloodstream infections by E. coli in England, Wales and Northern Ireland now show some signs of not responding to drugs.

The HPA said the NHS must be careful over antibiotic use and urged industry to look into developing new drugs.

There are two main families of bacteria known as gram-positive, such as MRSA, and gram-negative, which includes E. coli and other less common bugs Acinetobacter and Pseudomonas.

There are some cracks in the system, but they are not big ones yet Dr David Livermore, of the HPA

The HPA said there had been a drive to tackle MRSA in recent years which had helped reduce infection rates and led to a host of new antibiotics to be developed.

By comparison, the development of antibiotics targeting gram-negative bacteria such as E coli, which can cause a range of symptoms from mild diarrohea to abdominal cramps and kidney damage, was much less common.

The fight against drug resistance is an on-going battle because many bacteria constantly mutate, gaining resistance to current antibiotics in the process.

This is what has been happening in recent years to the likes of E coli.

HPA data shows that there are about 20,000 bloodstream infections of E. coli each year – although the true level of infections would be much higher if urinary tract infections were taken into account.

Of these, 12% show signs of resistance – up from about 4% at the turn of the century.

The infections are mostly not yet resistant to all forms of antibiotics, just what doctors call the first-line.

This means they are having to use back up drugs, which tend to have more side effects and raises the prospect of the widespread emergence of a new strain which is totally antibiotic resistant.

Cases

Indeed, reports have already emerged of such a scenario in Israel and the US, while four cases have been reported in the UK.

Dr David Livermore, an infections expert at the HPA, urged industry to start looking at developing new antibiotics.

But he added: “The NHS must be careful over its use of antibiotics to slow down the development of resistance.

“Hospitals must make sure they use the right dose, for the right length of time.

“GPs should not prescribe – nor patients expect – antibiotics for routine coughs and colds.

“Resistance has been accumulating. We are having to use reserve antibiotics more than previously… that is worrying.

“There are some cracks in the system, but they are not big ones yet.”

Cheap drug hope for breast cancer

In the UK, almost 46,000 new cases of breast cancer are diagnosed each year

A combination of two inexpensive existing drugs may offer a new way to treat breast cancer, according to UK and Finnish researchers.

The common chemotherapy drug and a brittle bone medicine almost completely stopped the growth of tumours in mice.

The Journal of the National Cancer Institute said the combination cost a twentieth of Herceptin, given to breast cancer patients by the NHS.

Specialists said the results of human trials now under way would be crucial.

The results of this study could change the way breast cancer patients are treated Pamela Goldberg Breast Cancer Campaign

In the UK, almost 46,000 new cases of breast cancer are diagnosed each year.

Although modern treatments mean that cases caught sufficiently early, some via breast screening programmes, have an excellent chance of being successfully treated.

The study was a joint project between researchers at the University of Sheffield and the Kuopio University in Finland.

Its findings could offer an even more effective way to help some patients.

It used a dose of the drug doxorubicin, a common component of chemotherapy regimes, followed 24 hours later by zoledronic acid, currently given to osteoporosis patients.

In the mice, this stopped 99.99% of new cancer cell growth in tumours.

It is thought the first drug could be “priming” the tumour to be more sensitive to the cancer-cell killing qualities of the second drug.

Dr Ingunn Holen, who led the study, said that the study showed that the drug cocktail could “kill breast tumours”.

“These results show that a patient may benefit the most if these two drugs are given in this particular order.”

She said that the results of a human trial were expected later this year.

Speed advantage

If that proves successful, the drugs would not have to undergo a lengthy licensing process, simply have the change of use included in their current licence.

Breast Cancer Campaign, the charity which funded the study, said it was encouraged by the potential for the drug to be made swiftly available to women.

Its chief executive, Pamela Goldberg, said: “The results of this study could change the way breast cancer patients are treated.

“The good news is the that the two treatments are relatively inexpensive and already used in the clinic.”

A spokesman for Cancer Research UK said that a study in humans would be important.

“Establishing the most effective combinations of drug treatments and the timings in which they are given is an important area of clinical research.

“But the benefits of giving zoledronic acid after doxorubicin have only been shown here in mice and now need to be evaluated more fully in people with breast cancer.”