The swine flu pandemic is in danger of masking other serious illnesses such as meningitis which may be misdiagnosed as a result, health experts warned yesterday.
Around 3,500 patients are hospitalised each year with meningitis, 50-60 per cent of whom are aged under five. Between 90 and 1,000 cases are in babies less than 12 months old.
Doctors said that however sophisticated the symptom-checker operated by NHS Direct, or by the NHS Pandemic Flu Service when it is launched, with any "mass" medical service some patients would inevitably slip through the net.
The warning came as it was disclosed that a 15-year-old died of swine flu in the Royal Hospital for Sick Children in Glasgow. She had underlying medical conditions, the Scottish Government said.
The World Health Organisation announced that more than 700 people worldwide are now thought to have died after contracting the virus.
Gemma Drury, 17, of Brimington, near Derby, was admitted to the High Dependency Unit of Rotherham General Hospital with meningitis last week, after being first diagnosed over the phone with swine flu.
The diagnosis was confirmed the following day by a doctor who visited her at home after she collapsed in the kitchen. She was taken to Chesterfield Royal Hospital before being sent home in the early hours of Thursday morning. She returned the next day when she was diagnosed with meningitis and transferred to Rotherham.
Her mother Dawn told the Derbyshire Times: "There is so much about swine flu, other things are being ignored. I wouldn't have thought it was meningitis. We are urging parents to look out for other things."
Bruce Laurence, deputy dirctor of public health at Derbyshire County Primary Care Trust, said: "It is a concern when a lot of people are coming down with one virus that other conditions could get missed, but our staff are being vigilant, particularly with children."
The Meningitis Research Foundation said yesterday that the pandemic could lead to a rise in meningitis cases, because flu lowers immunity, making sufferers more susceptible to other infections.
Last winter, cases of meningitis surged in January to 252, up from 190 the previous year, a month after flu peaked in December. Last winter's flu outbreak was the worst for nine years.
Harpinder Collacott, head of communications at the Foundation, said: "We have been worried about this for a while. Our major concern is that swine flu has the potential to mask other dangerous diseases like meningitis. Meningitis is the most dangerous infectious disease because it progresses so quickly. If you delay seeking treatment you risk facing a worse situation."
Ms Collacott said the symptom-checker used by NHS Direct was "fantastic" but only suitable for children over five. "Between 50 and 60 per cent of meningitis is in children under five." She added: "The three red flag symptoms of meningitis are cold hands and feet while the rest of the body has a fever, severe limb, joint and muscle ache, and pale and mottled skin. If parents are concerned about their children it is better to be safe than sorry and take them to the doctor."
Peter Holden, the lead on swine flu for the British Medical Association and a GP in Matlock, Derbyshire, who helped design the questionnaire for the National Pandemic Service, said: "The questionnaire is designed to weed out the 999 threats, like meningitis, right at the start. It doesn't matter what emergency it is. But this is mass medicine. It is inevitable that one or two will fall through the cracks. If you are getting hundreds of thousands of calls a day it is the only way to cope."
The existing NHS swine flu service, operated online and by phone by NHS Direct, is designed to enable the public to distinguish the symptoms from other emergency conditions which require a 999 call, for adults and children over five.
The National Flu Pandemic Service, due to be launched tomorrow, will be designed for adults and children to self-diagnose and obtain anti-viral drugs down to the age of 12 months. But the Department of Health said yesterday that it would still advise parents of children under five to stay in touch with their GP. Parents with babies aged less than 12 months who develop symptoms will be advised to take them to the GP. A spokesman for the health department said: "Thanks to vaccines, cases of meningitis are currently very low. "
Advice to the sick and 'worried well'
Q. What is the risk of catching swine flu?
A. About 100,000 people are estimated to have been infected in the UK. It is possible to have the virus without symptoms but by last week, 652 people had been hospitalised and 29 had died. The death of a 15-year-old girl in Scotland was also disclosed yesterday.
Q. When should I go to my GP?
A. People with suspected swine flu are being discouraged from attending surgeries unless they are in a high risk group – those with chronic illnesses, pregnant women, the elderly and children under five. Others are advised to use the NHS Direct "symptom checker" online or by phone, or via the NHS Flu Pandemic Service from tomorrow.
Q. Should I get pregnant?
A. Women who are expecting or planning a baby who want advice should follow guidance from the Department of Health.
Q. Should pregnant women avoid crowded places?
A. Avoiding crowds could reduce the chances of infection. The Chief Medical Officer, Sir Liam Donaldson, said he was not advising it but may do so when the pandemic peaks and up to one in three people are infected. Now, each woman should decide for herself.
Q. What is the risk of catching swine flu?
A. Among children it is spreading rapidly and the NHS has been told to plan for the infection of up to 50 per cent of the child population. In older people it is slightly less infectious, possibly because they have developed immunity from being exposed to flu in the past. Up to 30 per cent of adults are thought likely to become infected, three times the rate for normal winter flu. The elderly, while most protected, are more likely to become seriously ill.
Q. Should I take Tamiflu?
A. If you have swine flu but are otherwise healthy, probably not. The drug will, at best, shorten your illness by a day and the more people who take it the more likely resistance to it will grow. If, however, you are in one of the high risk groups already mentioned then you should probably take it to reduce the risk of complications such as pneumonia.
Q. What is the risk of dying?
A. About the same as for seasonal flu - that is, low. Seasonal flu caused 6,000 deaths in 2002-2003, when there was little flu about, and 21,000 deaths in 1999-2000, the last epidemic. Most deaths from seasonal flu are among the elderly. Swine flu is proving serious in children; the hospitalisation rate of under-fives is four times that of adults.
Q. When are people infectious and for how long?
A. From a day before symptoms appear, up to seven days after.
Labour's problems in this week's Commons by-election in Norwich North worsened yesterday when their candidate, Chris Ostrowski, was struck down with suspected swine flu. He collapsed at home yesterday and was taken by ambulance to Norfolk and Norwich Hospital, where he was later discharged. He is unlikely to have any contact with voters before the polls open tomorrow.
The Home Secretary, Alan Johnson, will be in Norfolk making a last-minute attempt to shore up the Labour vote today but it is widely expected that the seat, which has been Labour since 1997, will fall to the Conservatives.
The Tory candidate, Chloe Smith, said: "I'm extremely sorry to hear that Chris has been taken ill. One of my campaign team had a suspected case of swine flu two weeks ago so I know just how horrible it can be."