Thursday 19 11 09 00:05 UTC
 Warning from academics comes as Department of Health figures show sharp fall in number of new cases in youngsters
Swine flu vaccines to be given to healthy children The UK could run out of intensive care beds for children if there is a big surge in swine flu admissions in winter, according to medical researchers. The stark warning from Cambridge academics comes as the Department of Health today reveals its latest weekly review of critical care provision in the NHS for swine flu cases. Figures provided by the chief medical officer, Sir Liam Donaldson, show a reduction in the percentage of children with swine flu occupying paediatric intensive care beds in England. The pattern of H1N1 pandemic infections is proving unpredictable. Death rates are far lower than initially expected, with most victims young rather than old. The vaccination programme is already beginning to protect many of the most vulnerable. A sharp fall in the number of new cases last week may represent a temporary easing of the disease attributable to the school half-term break or the warm weather. The Cambridge research, published in the medical journal Archives of Disease in Childhood, warns that "paediatric critical care provision may prove to be inadequate". It says routine operations may have to be cancelled and adult intensive care beds given over to children. The researchers, led by Dr Ari Ercole and Dr D O'Donnell at Addenbrooke's hospital, studied a model developed by the US Centres for Disease Control to predict likely demand for critical care. Their work is based on the UK's current level of provision: 303 intensive care beds for children spread over 25 regional centres. The research assumes that children suffering from swine flu admitted to intensive care will stay for a minimum of five days and that the pandemic peak will last 12 weeks. It estimates that 3.8% of the UK's population of under-15s admitted to hospital for swine flu will require critical care. Their calculations show that if the admission rate is 1%, around half of the UK's critical care capacity will be needed. If this rate reaches 2%, almost all the current capacity will be needed. Critical care capacity for children varies by region, with some areas, such as Wales, the south-east coast and the east of England, likely to struggle with increased demand, the study suggests, even at a 1% admission rate. Pressure is likely to build up in regional specialist centres. "Respiratory illness is the second largest cause of Picu [paediatric intensive care unit] admission, accounting for approximately a quarter of all cases," the study says. "The 2009 influenza outbreak appears to still be in its early stages and the relatively small numbers of confirmed cases – with a lag between presentation and more severe illness – mean that there is uncertainty regarding its true pathogenic potential." Analysis of the ages of flu fatalities carried out by the department show that in a normal seasonal flu year 94% of deaths are among those aged 65 and over. In this swine flu outbreak, 21% of deaths are among those aged 14 and under, while 39% are among 15- to 44-year-olds. That pattern is thought to reflect the greater cumulative immunity among older people built up by their exposure to similar flu viruses. The department said yesterday: "Latest evidence indicates that the pandemic is unlikely to reach the potential worst-case scenarios issued last month. However, we must not underestimate the threat that swine flu still poses. Children are particularly at risk and are more likely to require intensive care treatment if they suffer complications. A central part of meticulous NHS planning has been paediatric critical care. As a result, critical care capacity for children can be substantially increased when needed. "Swine flu doesn't always affect every region in the same way at the same time, so different regions are geared up to support each other and use one another's facilities where necessary." Extra resources have been channelled into increasing the number of critical care beds, particularly the few equipped with Ecmo (extra-corporeal membrane oxygenation) technology that oxygenates the blood of patients outside of their body. The vaccination programme should continue to reduce numbers. Professor Robert Dingwall, former director of the institute for science and society at the University of Nottingham, said: NHS has planned for some expansion and should also be able to find extra capacity by moving older children into adult beds and postponing elective surgery."  Owen Bowcott
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