Football fans may be at risk as swine flu cases double

Published on Monday 1 June 2009 22:06

THE number of cases of swine flu in Scotland has more than doubled in 24 hours, as evidence started to emerge that the virus is spreading in the community.

Health secretary Nicola Sturgeon said 23 new cases of the H1N1 virus had been confirmed, bringing the total number in Scotland to 42.

The source of many of the new infections is not known, raising concerns that swine flu is spreading among the general public, rather than being directly linked to travel overseas.

Microbiologist Hugh Pennington said the high number of new cases suggested the virus was passing "under the radar" and was now in the community.

Before yesterday, Scotland had seen only 19 cases in the five weeks since swine flu emerged.

Experts believe the virus is likely to remain at low levels during the summer months, but potentially return with a vengeance in the winter.

Yesterday, Ms Sturgeon revealed that the bulk of the new cases were linked to football fans with flu symptoms on a Rangers supporters' bus that was returning to Dunoon, Argyll, following the Dundee United-Rangers SPL match on Sunday, 24 May.

Eighteen of the cases were reported in Dunoon – 11 passengers and seven of their contacts.

Two other bus passengers from Ayrshire and Arran and Greater Glasgow were also confirmed, along with a contact.

Another contact of a 37-year-old man who remains critically ill in hospital in Glasgow was identified with the virus, along with a pupil who returned to Edinburgh from Eton College – the location of an outbreak.

Ms Sturgeon said a further three probable cases – linked to the man in Glasgow's Victoria Infirmary – were being investigated. And 34 possible cases are also being tested – four travel-related and the other 30 non-travel-related.

Of the 42 cases now confirmed in Scotland, only seven are linked to travel. The cluster of cases in Dunoon led the Royal Bank of Scotland to close a branch in the town after a staff member fell ill.

About 180 third-year pupils and nine teachers from Dunoon Grammar School were also kept at home as a precaution after a 13-year-old pupil was unwell. In Glasgow, one of the new probable cases was a pupil at St Bride's Primary School, Craigie Street.

Ms Sturgeon said: "We are seeing more cases and… we are finding it more difficult in some of these cases to identify the source of the infection. That raises a suspicion, though there is no hard and fast evidence of this, that we are starting to see evidence of the infection being out there in the community."

Ms Sturgeon said that health officials were also investigating if any of the Rangers supporters on the bus affected by the outbreak had also been at Saturday's Homecoming Scottish Cup final at Hampden.

Public health officials have set up a Flu Response Control Centre, based in Glasgow, to provide extra support to health boards. The total number of those affected in the UK is now 278.

Professor Pennington said: "I think a reasonable guess is that it would not be surprising if the number of cases mounts and it doesn't take off as a major epidemic, but it continues to rise like it has done in Australia.

"It has got under the radar, it is creeping about, it's not doing very much mischief, but is spreading in schools or football supporters on a bus."

About 17,500 cases of swine flu have now been reported worldwide and there have been 115 deaths.

Figures could be the tip of a very large iceberg

HEALTH secretary Nicola Sturgeon has announced that confirmed cases of swine flu in Scotland appear to be increasing in a sporadic fashion, writes Tony Nash.

The question is whether the recent increase is a one-off, or whether it signifies the virus becoming endemic in the Scottish community.

Monitoring a virus within a broader community, not just in the clinic, is reliant upon tracing contact cases. This represents a major challenge as no sooner has the virus been identified, it has already moved on to the next group.

This is particularly true for influenza A H1N1 virus which is clearly highly contagious. The problem with this virus, as experienced outside Mexico, is that it causes only mild flu-like symptoms. This means some people infected with the virus will self-diagnose this as a summer cold – leading to such cases going unrecorded. For this reason, the actual figures for infected individuals are generally accepted to exceed the number of confirmed cases.

Insight into the Scottish, and more broadly the UK, context can be drawn from how the virus has been spreading through the rest of the world. The World Health Organisation's figures show that in Canada and the US there have been steady and large increases in confirmed cases. There have also been recent dramatic increases in Australia and Japan; while in Europe, Spain has a similar number of cases to the UK, but the rate of increase has slowed.

This contrasts with only a handful of confirmed cases in Germany and France. Why there is this level of variation, globally, is still a mystery. The fact that India currently has one confirmed case and Russia two, while the whole African continent has none, would lead to the conclusion that known cases – currently standing at around 15,000 – represent the tip of a very large iceberg.

Given the information available to health professionals in Scotland about the local status of the virus, it seems fair to assume there is a strong likelihood that the virus is now prevalent through much of the Scottish community and that therefore we will continue to see sporadic increases in the number of confirmed cases.

&#149 Professor Tony Nash is director of the Interdisciplinary Centre for Human and Avian Influenza Research and director of the Centre for Infectious Diseases at Edinburgh University.