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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.7 (PDF file, 196 KB)
Archives | News Archives 2004: Page 1 | 16 February 2006
News Archives: | 2006 | 2005 | 2004 | 2003
New guidance on post exposure prophylaxis for HIV
The Expert Advisory Group on AIDS (EAGA) has recently published revised guidelines (1) on the use of post-exposure prophylaxis (PEP) for HIV following occupational exposure. This document replaces the one issued in July 2000 ( 2) and can be viewed on the Department of Health's website at <http://www.advisorybodies.doh.gov.uk/eaga/publications.htm>.
The most substantial addition to the guidance is a new annex, Annex G, on PEP for patients following possible exposure to an infected health care worker. Such exposures are expected to occur rarely, but the guidance aims to facilitate a consistent approach to management of such incidents. It also serves as a reminder of the responsibilities of health care workers to seek and follow confidential advice on whether they should be tested if they may have been exposed to a blood-borne virus (HIV, hepatitis B, or hepatitis C).The key points raised in the guidance are detailed below.
-
Clarification on how and when a source patient should be approached for HIV testing where their status is not known, including obtaining informed consent for testing the sample.
- A change in the antiretroviral drugs recommended for use in PEP starter packs from indinavir to nelfinavir, 1250 mg twice daily (or 750 mg three times a day) along with zidovudine, 250 or 300 mg twice daily and lamivudine, 150 mg twice daily.
- Prime importance must always be the prevention of avoidable exposure ( [3] ).
- Every NHS employer should have a policy on the management of exposures, which ensures 24-hour cover is available.
- Accurate risk assessment of the incident to identify significant exposure, prior to obtaining consent from the source patient for testing.
- The use of PEP is unlikely to be justified in the majority of exposures where the source patient is unknown. This decision should be underpinned by a case-by-case risk assessment.
- PEP should not be offered if the source is HIV negative, or, following a risk assessment that suggests that the risk of HIV infection is highly unlikely.
- Baseline blood sample from the health care worker should be stored for two years and the health care worker should be informed of the retention policy at the time the sample is taken.
- Enhanced surveillance for occupational exposure to blood borne viruses is in operation (4). Occupational health physicians and clinicians involved in the care of exposed health care workers are encouraged to report to the Health Protection Agency's Communicable Disease Surveillance Centre, Colindale, or the Scottish Centre for Infection and Environmental Health (SCIEH).
It is anticipated that this document will also provide a framework for professions outside the health care setting (eg, police, fire service, voluntary aid agencies, armed forces) when they are developing guidance relevant to their own occupational setting.
Guidelines for the provision of PEP following sexual (ie, non-occupational) exposure are being prepared by the HIV Special Interest Group of the British Association for Sexual Health and HIV (BASHH).
References
1.Department of Health. HIV Post-Exposure Prophylaxis: guidance from the UK Chief Medical Officers' Expert Advisory Group of AIDS. London: Department of Health, 2004. Available at <http://www.advisorybodies.doh.gov.uk/eaga/publications.htm>.
2.Department of Health. UK Health Departments. HIV post-exposure prophylaxis: guidance from the UK Chief Medical Officers' Expert Advisory Group on AIDS. London: Department of Health, 2000.
3.Department of Health. UK Health Departments. Guidance for clinical health care workers: protection against infection with blood-borne viruses; recommendations of the Expert Advisory Group on AIDS and the Advisory Group on Hepatitis [HSC 1998/063]. London: Department of Health, 1998.
4.Health Protection Agency. Surveillance of Occupational Exposure to Bloodborne Viruses in Health Care Workers. London: HPA, 2004. Available at: <http://www.hpa.org.uk/infections/topics_az/bbv/bbmenu.htm>.
Avian influenza (H5N1) among poultry in south east and east Asia, and humans in Viet Nam and Thailand
Outbreaks of avian influenza in poultry
Confirmed or suspected outbreaks of avian influenza (H5N1) remain widespread among poultry in China (14/31 provinces, autonomous regions, and municipalities), Thailand (40/76 provinces), and Viet Nam (28/64 provinces). In addition by 11 February 2004, the World Health Organization (WHO) has confirmed outbreaks of avian influenza (H5N1) among poultry in Cambodia, Indonesia, Japan, Laos, and South Korea.
Unconfirmed data from the World Organisation for Animal Health (OIE) indicate that antibodies to influenza A (H5N1) have been found in pigs in Viet Nam. The potential susceptibility of pigs to avian influenza viruses is well known, and OIE is advising countries infected with avian influenza viruses to closely monitor pigs that are in contact with infected birds, and cull those in which the presence of the virus is confirmed. <http://www.oie.int/eng/press/en_last.htm>.
Influenza A (H7) has been reported in a poultry flock in Delware State in the United States <http://www.oie.int/eng/info/en_urgences.htm>. This virus appears to be a low pathogenic strain of avian influenza (LPAI), which very rarely transmits to humans and causes severe illness. A flock of 12,000 birds has been culled to prevent further spread of the virus. Avian influenza (H7) has also been reported in Pakistan, and influenza A (H5N2) has been reported in Taiwan. Further information is available
at:<http://www.oie.int/downld/AVIAN%20INFLUENZA/A_AI-Asia.htm>.
Human cases of avian influenza
Viet Nam and Thailand are the only countries that have reported human cases of infection. As of 10 February 2004, Viet Nam has reported 18 cases, 13 of whom have died, and Thailand has reported five cases, all of whom have died. It is anticipated that human cases will also be detected in other countries where outbreaks in poultry are occurring.
Evidence, to date, suggests that the H5N1 strain is not easily transmitted from poultry to humans. Data also suggest that the virus has not become adapted to be transmitted easily from one human to another. Sequence data from one of the sisters in a family cluster in Viet Nam indicates that the virus was of entirely avian origin, with no human genes. The virus from the second sister is being sequenced this week .
<http://www.who.int/csr/don/2004_02_06/en/>
<http://www.who.int/csr/don/2004_02_09/en/>
The threat of avian influenza A (H5N1) to the United Kingdom remains low at this time. Interim guidelines for the surveillance of suspected human cases of avian influenza are available on the HPA website:
<http://www.hpa.org.uk/infections/topics_az/avianinfluenza/guidelines.htm>.
Updated information is available on the avian influenza topic page of the HPA website:
<http://www.hpa.org.uk/infections/topics_az/avianinfluenza/menu.htm>.
The European Parliament has passed legislation creating a European Centre for Disease Prevention and Control
The European Parliament passed an opinion on 10 February 2004, bringing the new European Centre for Disease Prevention and Control (ECDC) into being (1). This legislation has been fast-tracked since July 2003, when both the European Parliament and Council recognised the importance of having such a centre when the European Commission presented the draft proposal. The opinion still has to be passed by national governments at a European Council meeting to become law.
The European Commissioner for Health and Consumer Protection welcomed the vote, citing the events of the past year with regard to avian influenza and SARS as being strong proof that increased cross-border collaboration and coordination was necessary to enable European countries to be prepared for threats posed by global diseases.
To date, the European cooperation in investigating and controlling disease has been ad hoc, although the European Union does have a system for pan-European epidemiological surveillance of infectious disease. The new ECDC will provide the opportunity for substantial reinforcement of the current system, and has the backing of the state epidemiologists from member states <http://europa.eu.int/comm/health/ph_overview/strategy/ecdc/ecdc_en.htm>.
It will enable Europe to coordinate and mobilise its considerable disease control expertise efficiently and systematically, and improve effective communication to national governments and public health authorities.
There are already many Europe-wide disease surveillance systems and networks in existence, and the ECDC will make use of the expertise and working relationships already established. The initial focus of the Centre will be communicable disease and outbreaks of diseases of unknown origin as well as monitoring and preparedness planning against bioterrorist attacks. After three years of operation, the focus may widen to include other public health activities, such as health monitoring.
The ECDC is on track to begin functioning in 2005, and work is underway to select a management board. The Centre will be based in Sweden (2), although a precise location is yet to be announced.
References
1.EUROPA (portal site of the European Union). 'EU will be better prepared for future epidemics' says Byrne as Parliament backs new health agency. (press release) IP/04/190. EUROPA, 10 February 2004. Available at <http://europa.eu.int/rapid/start/cgi/guesten.ksh?p_action.gettxt=gt&doc=IP/04/190|0|RAPID&lg
=EN&display=>.
2. Von Holstein I. Ministers decide the ECDC shall be in Sweden and the EFSA in Italy. Eurosurveillance Weekly [serial online] 2003 [cited 12 February 2004]; 7(11). Available at <http://www.eurosurveillance.org/ew/2003/031218.asp>.
Call for abstracts at the Health Protection Agency Annual Conference 2004
Abstract submissions for oral and poster presentations at the Health Protection Agency Annual Conference 2004 are invited from 12 February. These presentations will form an important element of the conference, and provide researchers with a prestigious opportunity to bring their projects to the attention of a wide audience within health protection and public health.
Abstracts are invited that fit topics within the main themes of the Conference (Children's Health, International Health, and Risk Communication) and other selected categories, which reflect the scope of the HPA including Environmental, Epidemiology, Medical Treatment and Control Strategies, Methodologies, and Surveillance.
For full details about abstract submission (before 22 April), please visit <http://www.hpaconference.org.uk>.
