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Final Issue: Volume 16 Number 51 |
Published on: 21 December 2006 |
Final Issue in PDF |
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News Archives
Last updated: Volume 14, No.52 (PDF file, 517 KB)
Archives | News Archives 2004: Page 1| News Archives 2005 Page 2 | News 16 December 2004
News Archives: | 2006 | 2005 | 2004 | 2003
Salmonella Thompson outbreak in the UK unrelated to European outbreaks
A report through the international Enter-net network of an outbreak of Salmonella Thompson in Norway in mid-November 2004 led to an examination of recent referrals to the Health Protection Agency's Laboratory of Enteric Pathogens (LEP). This revealed that there had been a small national outbreak of S. Thompson phage type (PT)3 in September and October 2004, affecting three areas of England .
From 1 September to 30 November 2004, LEP reported on 46 human isolations of S. Thompson. Of these, 31 were S. Thompson PT3, fully sensitive to all antimicrobial agents, and eight were S. Thompson PT1a resistant to sulphonamides and trimethoprim, of which six were connected with an outbreak in a young offenders' institution. The remaining isolates were PT1 (five cases), and PT6 and PT7 (one case each). The cases of S . Thompson PT3 were distributed throughout England and the majority occurred in September 2004. Eight-four per cent of cases were aged between 15 and 64 years and 60% were female. No non-human isolates of S. Thompson PT3 have been recorded in 2004. The outbreak of S . Thompson PT3 occurred at the same time as a much larger outbreak of the morphologically-similar serotype S. Newport , with over 650 cases. In 2003, LEP reported on seven cases of S. Thompson PT3, of which four had been abroad ( Greece 2, and one each in Thailand and Spain ), and two isolates from raw burgers. The source of the S. Thompson PT3 outbreak in England and Wales in September 2004 is unknown.
Since September 2004, outbreaks or cases of infection with S. Thompson have occurred in three other European countries. In particular, there was an extensive outbreak in Norway in November 2004, associated with ruccola (rocket) salad imported from Italy (1, 2). Isolates of S. Thompson PT3 from England have been studied using pulsed-field gel electrophoresis (PFGE). All the English strains have a distinct pulsed-field profile provisionally designated S . Thompson PFGE type B. This profile has been compared with electronically-transmitted PFGE profiles of isolates of S. Thompson from outbreaks or cases of infection in Norway , Sweden , and Denmark made since September 2004, and also with isolates produced in Sweden , but derived from S. Thompson from Italian ruccola salad. At least two PFGE profiles were identified in the isolates from Norway , Sweden , Denmark , and Italy , both of which were different to that of the type B profile from the S. Thompson PT3 isolates from England .
There is no evidence that the implicated ruccola salad was imported into the UK from Italy in September 2004. The conclusion is that the strain of S. Thompson PT3 responsible for the small outbreak in England in September 2004 is different to those that have caused outbreaks or cases of infection in Norway, Sweden, and Denmark since November 2004, and also different to strains from ruccola salad originating in Italy.
References
| 1. | Nygard K, Lassen J, Aavitisland P. Outbreak of Salmonella Thompson infections caused by contaminated ruccola (rocket) salad. Eurosurveillance Weekly [serial online] 2004 [cited 23 December 2004]; 8(48). Available at <http://www.eurosurveillance.org/ew/2004/041125.asp>. |
| 2. | Nygard K, Lassen J, Vold, L, Aavitisland P, Fisher I. Outbreak of Salmonella Thompson infections caused by contaminated ruccola salad - update. Eurosurveillance Weekly [serial online] 2004 [cited 23 December 2004]; 8(51). Available at <http://www.eurosurveillance.org/ew/2004/041216.asp>. |
Enhanced tuberculosis surveillance: 2002 final and 2003 preliminary results
Note! On 11 March 2005, data values in this article were amended (click here to see changes), the full erratum was published in CDRWeekly volume 15 no. 11 15(11), 17 February 2005.
The data for tuberculosis cases reported in 2002 to the Enhanced Tuberculosis Surveillance System has now been finalised. The main findings are: 6861 cases were reported in England, Wales, and Northern Ireland (table 1) which represents an overall rate of 12.7 per 100,000 population (England 13.4, Wales 5.3, and Northern Ireland 3.9). Compared to 2001, the overall number of cases has increased by 3.1% and the rate by 2.4%.
Table 1 Number of tuberculosis case reports and rate, England, Wales, and Northern Ireland: 1999 to 2002 (Enhanced Tuberculosis Surveillance - final results)
| Year | Number of cases | Rate per 100, 000 population |
| 1999 | 5761 |
10.8 |
| 2000 | 6323 |
11.8 |
| 2001 | 6652 |
12.4 |
| 2002 | 6861 |
12.7 |
London accounted for 44% of all cases reported and had the highest rate (40.6 cases per 100,000 population) of all the regions/countries. The Midlands and the North West regions accounted for 28% of cases and outside London the regions/countries with the highest reported rates were West Midlands (15.2), East Midlands (11.6), and Yorkshire and Humber (10.3).
Where place of birth was known, the proportion of cases born abroad in 2002 was 67.1% compared to 62.6% in 2001. In 2002, the tuberculosis rate was 22 times higher in the foreign born population (rate 90 per 100,000 population) than in those born in the UK (4.1 per 100,000).
The combined ethnic group of Indian, Pakistani, and Bangladeshi make up the highest proportion of cases (36.9%) followed by the White (26.8%) and Black African (21.4%) ethnic groups. The number of cases in the Black African ethnic group increased by 38% in 2002.
The proportion of isoniazid resistance in culture-confirmed cases with a known drug susceptibility result increased from 6.7 % in 2001 to 7.1% in 2002. The overall level of multi-drug resistance (resistance to at least isoniazid and rifampicin) remained stable at 0.8% compared to 0.8 % in 2001.
The finalising of data involves checking and cleaning the national database and linking the reports to reference laboratory information (Mycobnet) for culture and drug susceptibility results. The annual report for the finalised 2002 data will be published in January 2005.
Provisional data for 2003 enhanced tuberculosis surveillance is also now available. There were 6,933 cases reported in England, Wales, and Northern Ireland in 2003 compared to the equivalent provisional figure of 6974 cases in 2002. This represents an overall rate of 12.7 per 100,000 population (England 13.6, Wales 5.4, and Northern Ireland 3.9), which is a little lower than the provisional rate for 2002 of 12.9 per 100,000 (England 13.5, Wales 5.8, and Northern Ireland 3.4).
Final data for 2002, and 2003 provisional data tables and figures can be accessed on the Health Protection Agency’s Centre for Infections tuberculosis website, available at: <http://www.hpa.org.uk/infections/topics_az/tb/data_menu.htm>.
Changes to this article, 11 March 2005:
1. In the second sentence of the first paragraph , 'The main findings are: 6681' was changed to 'The main findings are: 6861'
2. In the first sentence of the second paragraph, 'London accounted for 45% of all cases reported' was changed to 'London accounted for 44% of all cases reported'
3. In the first sentence of paragraph five, ' cases with a known drug susceptibility result increased from 6.7 % in 2001 to 7.1% in 2002' has been amended to ' cases with a known drug susceptibility result increased from 6.7 % in 2001 to 7.0% in 2002'.
The full erratum was published in CDR Weekly volume 15 no. 11 15(11), 17 March 2005, available at:
<http://www.hpa.org.uk/cdr/archives/2005/cdr1105.pdf>.
Withdrawal of baby milk Pregestimil worldwide following possible link with fatal Enterobacter sakazakii infection in infants in France
On 22 December, the Department for Health (England) and the Food Standards Agency drew the attention of healthcare professionals to the global full trade withdrawal of Pregestimil® powdered infant formula from the international market by Mead Johnson Nutritionals (1).
The company has withdrawn the product following a possible link to five cases of presumed Enterobacter sakazakii infection in premature infants in France between October and December 2004, which led to the death of two infants. E. sakazakii is an opportunistic pathogen that poses little risk to healthy, term infants. Premature, low birth weight and immunocompromised infants are specifically at risk. Previous E. sakazakii infections have been associated with poor hygiene and storage of reconstituted powdered infant formula (2,3) . In this instance the organism has not yet been detected in Pregestimil, but this is not uncommon when there is low level contamination of milk products. As a precautionary measure, the company has withdrawn the product worldwide. Further investigations are continuing in France to identify the source of the infection (4).
The batch of the product under investigation was not distributed in the United Kingdom (UK) and supplies of Pregestimil in the UK are not implicated. An initial investigation of reports received by the Health Protection Agency’s Centre for Infections, to date, shows no reports of confirmed E. sakazakii in children in the second half of 2004. Since the extent of any contamination is not known there may be contaminated batches in the UK. Any laboratory that identifies E. sakazakii even presumptively should immediately contact the referring physician to check whether the source patient is an infant taking baby milk, and if so to urgently inform the local Health Protection Unit or the CDSC duty doctor at the Centre for Infections, tel: 0208 200 6868. Since other organisms may initially appear to be E. sakazakki, any such isolates should be referred to the Centre for Infections, for the attention of Tyrone Pitt, email: <tyrone.pitt@hpa.org.uk>. Outside working hours the SRMD duty doctor should be contacted via telephone: 020 8200 4400.
Pregestimil is a hydrolysed protein formula usually prescribed for infants who have fat and/or protein malabsorption. As it will not be available in the UK until further notice, health professionals are being advised to prescribe other suitable alternatives. Infants currently being fed Pregestimil can continue until an alternative prescription is obtained. The importance of good hygiene practices in preparing formula feeds from powdered formula is being re-emphasised to parents. Instructions are set out in the leaflet Bottle Feeding available on the Department of Health website (5). In particular, it is important to store made-up formula in the coldest part of the fridge, preferably at 5°C for no more than 24 hours and throw away any left over milk.
| 1. | Department of Health. Withdrawal of Pregestimil® by Mead Johnson Nutritionals . London : Department of Health, December 2004. Available at <http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/MaternalAndInfantNutrition/MaternalAndInfant NutritionGeneralArticle/fs/en?CONTENT_ID=4099143&chk=gVT9%2Bl>. |
| 2. | Lai KK. Enterobacter sakazakii infections among neonates, infants, children, and adults: case reports and a review of the literature. Medicine 2001; 80 :113-22. |
| 3. | Muytjens HL, Kollee LA. Enterobacter sakazakii meningitis in neonates: causative role of formula? Pediatr Infect Dis J 1990; 9: 372-73. |
| 4. | Institut de veille sanitaire [online]. Infections à Enterobacter sakazakii chez des nouveaux-nés ayant consommé du Pregestimil®, préparation pour alimentation des nourrissons et enfants en bas âge, France , octobre à décembre 2004, Institut de veille sanitaire. Available at <http://www.invs.sante.fr/display/?doc=presse/2004/le_point_sur/pregestimil_211204>. |
| 5. | NHS/Department of Health. Bottle feeding. London : Department of Health 2004.Available at <http://www.dh.gov.uk/assetRoot/04/08/44/54/04084454.pdf>. |
Changes to Aventis Pasteur MSD Vaccine Information Service
From 1 January 2005, Aventis Pasteur MSD will be making changes to the way in which they provide medical information through their Vaccine Information Service (VIS) (1). General vaccination information and travel health advice will be available through their web-based (database driven) Vaccine Information Service (VIS),
available at <http://www.apmsd.co.uk/>. Information relating exclusively to Aventis Pasteur MSD products will continue to be available from their medical information department on tel: 01628 587693. Queries related to vaccines and products of other pharmaceutical companies should be directed to the individual company.
The online VIS provides detailed information on travel, adult, and childhood vaccines, and news on outbreak and vaccine recommendations for all countries worldwide. It also includes travel-health advice including maps, current outbreak information, and specific travel advice country-by-country. The service also provides information to help answer individual clinical queries or problems relating to vaccination.
Healthcare professionals can register for VIS online free of charge using their GMC/NMC/RPS number.
Healthcare professionals who require pre-travel health advice for travellers with complex queries (such as those with special health needs or those with complicated travel itineraries) are advised to use the National Travel Health Network and Centre (NaTHNaC) telephone advice line, tel: 020 7380 9234.
Aventis Pasteur MSD, in conjunction with NaTHNaC and the Department of Health, has compiled a list of useful sources of travel health advice for healthcare professionals (2), which includes websites (free of charge), telephone advice lines and a list of standard travel medicine texts and literature.
References
1.
2.
Watching the detectives - celebrating the 10th year of EPIET, 18 January 2005
The Health Protection Agency’s (HPA) Centre for Infections is hosting an open one-day meeting on 18 January 2005 to celebrate the tenth year of the European Programme for Intervention Epidemiology Training (EPIET) <http://www.epiet.org/>. The day is organised in partnership with EPIET training sites in the Five Nations of England, Ireland, Northern Ireland, Wales, and Scotland.
EPIET is an elite field epidemiology training programme, which has been funded by the European Commission DG Sanco since 1995. Field epidemiologists apply rigorous scientific investigative methods to identify and solve urgent public health problems. Field epidemiologists discover and find the cause of outbreaks and epidemics and work out how to bring them under control. For this reason they are often thought of as ‘health detectives’.
Of the 117 EPIET fellows and associates from the past decade, more than 40 have had a connection with the Five Nations, either by being one of the 26 people who have come here for training from one of ten other European countries, or by being sent by the UK (ten people) or Ireland (four people) to train in one of seven other countries in Europe. Together they are building a safer more responsive public health capacity for the whole European Community.
The day aims to illustrate the contribution of EPIET to European public health through presentations from EPIET fellows and alumni on the wide range of work they have carried out during and after their training. The investigations have been carried out in all sorts of different settings and on scales ranging from families and local hospitals in various European countries to refugee camps in Darfur, Sudan. What they have in common is a rigorous investigative and scientific approach to defining and solving critical public health problems. The day includes presentations which have previously only been made in closed meetings.
The European Commission’s DG SANCO had the foresight to support EPIET before events such as SARS and avian influenza raised the priority of having such a network of highly trained professionals available across Europe. The European Commission has now given this priority even greater recognition through recently establishing the European Centre for Disease Control (ECDC), which will be supported by the EPIET network of fellows and alumni. This European response capacity is vital for professionals to share information, communicate warnings, and co-ordinate investigations of infections which spread across borders.
This event will be of interest to anyone working in field epidemiology and health protection, in international public health and in training, as well as anyone interested in how the European Commission is working to protect public health. For further information about this event or to find out about attending it, please contact Vivienne Fitch, email <vivienne.fitch@hpa.org.uk>. A draft programme is available from the CDR Weekly Diary section at: <http://www.hpa.org.uk/cdr/pages/diary.htm#epiet>.
