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Mr. Stephen O'Brien: To ask the Secretary of State for Health what evidence was taken into account in making the decision to implement leucodepletion in 1999 to prevent the risk of contracting vCJD through blood transfusions; and whether additional evidence will be required to inform decisions on implementing prion filtration. 
Dawn Primarolo: Expert advice at the time suggested that prion infectivity could be associated with the white cells (leucocytes) in the blood. It was therefore considered prudent to minimise any risk by removing the majority of these cells (without detriment to the transfusion). Although introduced primarily as one way of reducing any risk of variant Creutzfeldt-Jakob disease transmission, leucodepletion has a number of other benefits. For example, there is evidence that it reduces some of the risks of adverse reaction to transfusion.
Dawn Primarolo: The impact of immigration on health is more directly reflected in the health status and the underpinning determinants of health of specific ethnic minority groups, than of immigration. In general, we know there is a strong link between ethnicity, deprivation and poor health, but it is also important to recognise that there is considerable diversity between different ethnic groups. No specific studies have been recently commissioned by the Department of the general impact of internal migration.
The impact of poverty including relative income, child poverty and fuel poverty on health status and so on health inequalities has long been recognised. Sir Donald Achesons Inquiry into Inequalities in Health, which was commissioned by the Government, highlighted issues surrounding poverty and income, education, employment and environment. This approach reflected the scientific evidence that emphasised the interrelated nature of the causes of these inequalities. The Governments strategy Tackling Health Inequalities: A Programme for Action, set out the Governments response to these issues, including poverty.
Harry Cohen: To ask the Secretary of State for Health how many and what proportion of those eligible have taken up Healthy Start vouchers in (a) the Leyton and Wanstead constituency, (b) Redbridge, (c) Waltham Forest, (d) London and (e) England. 
Dawn Primarolo: The number of women and children eligible for Healthy Start at any given point in time varies. However, we estimate that take-up of the scheme in England is currently approximately 87 per cent. This is equivalent to around 342,000 beneficiary households.
Information on take-up at local level is not yet available, but we are planning to extract information from the Healthy Start database at strategic health authority or primary care trust level later in 2008. This will enable us to provide feedback to the national health service on the impact of Healthy Start at local level to support local delivery of public health policies.
Mr. Hands: To ask the Secretary of State for Health how many cases of catheter-related bloodstream infections occurred in the NHS in each of the past five years, broken down by strategic health authority area. 
Tom Brake: To ask the Secretary of State for Health what recent assessment he has made of the effectiveness of the human papilloma virus (a) vaccination and (b) screening programme; and if he will make a statement. 
Dawn Primarolo: Human Papilloma Virus (HPV) vaccines have been shown to be extremely effective in protecting women against the HPV strains that cause 70 per cent. of cervical cancers. The vaccine needs to be given before girls become exposed to the virus in order to provide protection.
The National Health Service Cervical Screening Programme is likely to continue for many years after the introduction of the HPV vaccine. This is because the vaccines only offer protection against 70 per cent. of cancer-causing HPV types, and it will be 13 years before the first 12-year-olds vaccinated will be eligible for cervical screening. Screening will also still need to be offered to women up to the age of 64 who will not have been vaccinated.
As part of the Liquid Based Cytology (LBC) pilot, which evaluated the use of the LBC technique in cervical screening, HPV testing as triage for women with mild or borderline test results was also piloted.
Following receipt of the positive independent evaluation of the HPV arm of the pilot, the Advisory Committee on Cervical Screening set up a dedicated working group to advise on how best to introduce HPV testing into the cervical screening programme.
As a result of this, a number of sentinel sites began triaging women with mild and borderline screening results in late 2007. Results from these sites will be known by 2009, at which point further roll-out can be considered.
Norman Lamb: To ask the Secretary of State for Health how many embryos from in vitro fertilisation programmes have been (a) donated to and (b) created for scientific research in each year since 1999. 
Dawn Primarolo: The Human Fertilisation and Embryology Authority (HFEA) has informed me that its register indicates that only two embryos have been created specifically for research purposes and this occurred in 2001.
Virtually all the embryos used in research have been donated by patients who no longer wished to use them in their own treatment. The number of embryos donated for research purposes each year since 1999 is shown in the following table.
|Embryos donated for research purposes since 1999|
|Number of embryos donated for research|
A long-term analysis of the HFEA register data 1991-2006, HFEA June 2007
John Mann: To ask the Secretary of State for Health how many specialist consultants in the NHS there are who treat patients with (a) chronic bronchitis and (b) chronic obstructive pulmonary disease. 
Ann Keen: The number of specialist consultants in the national health service who treat patients with chronic bronchitis and chronic obstructive pulmonary disease is not collated. However, such information is shown in the following table.
|Hospital and community health services: medical staff within the cardiology and respiratory medicine specialties , England at 30 September 2006|
|All staff||Of which : consultant|
The Information Centre for health and social care Medical and Dental Workforce Census.
Mr. Lansley: To ask the Secretary of State for Health (1) whether he has identified triggers at which point the use of antivirals in the event of an influenza pandemic becomes so great that the introduction of clinical prioritisation will be necessary; 
(2) whether the Government intend to consult on proposals for the clinical prioritisation of antivirals in the event of the stockpile of antivirals becoming depleted, as stated on page 38 of his Departments National Framework for responding to an influenza pandemic. 
Dawn Primarolo: The current antiviral stockpile should be sufficient to treat all who fall ill in a pandemic of similar proportions to previous ones in the 20th century but we recognise that prioritisation may need to be triggered if the clinical attack rate is higher than anticipated and/or antivirals are in greater demand than anticipated.
The Government have already consulted on the ethical principles underlying issues such as prioritisation, but their implications will need to be reviewed and updated in the light of emerging scientific and other information at the time of a pandemic. Further testing of the publics reactions to many issues in pandemic planning and decision-making will start with an engagement programme to facilitate this process, with the active participation of the public, beginning in the new year.
Mr. Lansley: To ask the Secretary of State for Health what means he has established to allow for the (a) assessment of the clinical attack rate of the first wave of a pandemic, (b) monitoring of the pandemic virus for genetic mutations which may affect the degree of protection and (c) monitoring of the pandemic virus for antiviral susceptibility, in between waves of a pandemic, as recommended on page 71 of his Department's National Framework for responding to an influenza pandemic, published on 22 November; and if he will make a statement. 
Dawn Primarolo: For all three surveillance elements mentioned, international information exchange, led by the World Health Organisation (WHO), will play an important role. The United Kingdom is actively engaged in international surveillance work and planning via both the WHO and the European Centre for Disease Prevention and Control.
It is envisaged that some information allowing estimation of the possible UK clinical attack rate of the first wave of a pandemic will be obtained via the WHO from the country of origin of the pandemic. Once it is in the UK, it is planned that more detailed data on the first few hundred UK cases will be obtained via the pandemic influenza management system that is currently being developed. It is an extension of the Health Protection Agencys avian influenza database. This will allow more accurate estimates of the UK clinical attack rate. Analysis of calls to the Flu Line, combined with real time modelling, will continuously improve the accuracy of the estimate of the clinical attack rate as the pandemic progresses.
Adaptation of existing surveillance systems and development of new systems is under consideration to further improve upon the clinical impact data available in the course of a pandemic.
Genetic analyses of the pandemic virus will be performed by the National Respiratory Virus Reference Unit in Colindale, which includes the WHO National Influenza laboratory. Analyses will be performed throughout the pandemic. The sampling schedule will change in the course of the pandemic. International information exchange, led by the WHO, will also provide valuable genetic monitoring information in the global course of the pandemic.
The UK is an active participant in the Neuraminidase Inhibitor Susceptibility Network which monitors susceptibility of neuraminidase inhibitors to influenza viruses found in the community. Influenza neuraminidase inhibitor antiviral susceptibility testing in the UK is provided at the National Influenza Centre in Colindale. Surveillance systems currently under consideration for use during a pandemic, are also being evaluated as to their potential to provide data on the proportion of antiviral treatment failures, both to inform on the potential development of a resistant virus and to improve on treatment regimes.
(5) which (a) organisation and (b) individuals his Department is consulting to (i) develop a suitable algorithm and (ii) produce model protocols/guidelines to allow the supply of oseltamivir during an influenza pandemic, as stated on page 102 of his Departments National Framework for responding to an influenza pandemic; when he intends the (A) algorithm and (B) model protocols/guidelines to have been finalised; and if he will make a statement; 
Dawn Primarolo: Antivirals are a key part of the Government response to an influenza pandemic, as stated in the National framework for responding to an influenza pandemic. We have stockpiled 14.6 million doses of Tamiflu, sufficient to treat 25 per cent, of the United Kingdom population. Owing to the logistical issues involved in building up such a large stockpile, supplies were delivered over a period between August 2005 and September 2006.
We plan to increase our stockpile of antivirals and antibiotics, but a precise timeline can not be given. This is because the procurement of the additional
countermeasures will be subject to normal commercial procurement procedures to ensure that we purchase these products at the best price and achieve value for money.
The Government are increasing their stock of antibiotics to treat the complications arising from an influenza pandemic. It will enable us to provide antibiotics for vulnerable symptomatic flu patients before secondary complications develop.
During a pandemic, national health service walk-in centres will be critical in continuing to provide fast access to health advice and treatment. They will continue to work alongside existing services in providing access to health advice, information and treatment of minor illnesses. Symptomatic patients will be encouraged to remain at home to limit spread of the influenza virus, and to contact the National Flu Line service as a first port of call.
The national clinical algorithm that will be used in the Flu Line Service to assess patients and determine their eligibility to antiviral treatment during a pandemic has been developed with the involvement of a wide range of stakeholders. These include expert clinicians and professionals from across the UK, representatives of specific health and social care services including the ambulance service, and representatives from the appropriate royal colleges. The algorithm is in the final stages of development and will be published shortly.
The protocol and guidelines that will allow the issuing of antiviral medicines have also been developed with input from a wide range of professionals, and are currently subject to public consultation as described in the Possible amendments to medicines and associated legislation during an influenza pandemic consultation document. The protocol and guidelines will be finalised after the consultation period ends on 22 February 2008.
Mr. Lansley: To ask the Secretary of State for Health pursuant to the statement of 22 November 2006, Official Report, column 1350, on pandemic influenza, for what reasons the stockpiles of (a) antibiotics, (b) pre-pandemic vaccines and (c) antivirals announced in his statement differ to the sizes of stockpiles recommended by his Department's Pandemic Influenza Scientific Advisory Group in its subgroup on modelling: modelling summary published in November 2007. 
Dawn Primarolo: The Scientific Advisory Group modelling sub-group summary does not recommend any specific stockpile levels. It summarises the outcomes of calculated simulations of several different situations taking a variety of counter-measures options, clinical attack rates and case fatality rates as scenarios.
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