 |
Subscribe to CDR |
Search CDR
powered by
Latest content
 |
Vol 16 no 51 |
 |
CDR RSS feed About RSS |
Adobe Acrobat
This site uses Adobe Acrobat
Download here >
|
||
|
Final Issue: Volume 16 Number 51 |
Published on: 21 December 2006 |
Final Issue in PDF |
|
||
News Archives
Last updated: Volume 14, No.11 (PDF file, 180 KB)
Archives | News Archives 2004: Page 1| News 11 March 2004
News Archives: | 2006 | 2005 | 2004 | 2003
Tuberculosis surveillance: notifications and enhanced surveillance
Surveillance for new cases of tuberculosis in England and Wales employs two different reporting systems: statutory Notification of Infectious Disease (NOIDS) and Enhanced Tuberculosis Surveillance (ETS). Since 1912, it has been a statutory legal requirement in England and Wales to notify all cases of clinically diagnosed tuberculosis through NOIDS to ensure that all cases and their contacts are managed appropriately, and to contribute to local and national surveillance. ETS was established in 1999 with the specific aim of providing more detailed and comparable information on the occurrence of tuberculosis in England and Wales.
Following the introduction of ETS, the number of formally notified cases has generally exceeded the number of cases reported through ETS. Notifications include some cases subsequently found not have tuberculosis (some of which are de-notified) and some duplicate reports. The ETS system is able to exclude such reports and provide a more precise estimate of the true incidence of tuberculosis in England and Wales. At present, data from the ETS system are only available 12 months or more after the year of report. The more rapidly available notification data provides a useful preliminary estimate of case numbers. Work is currently underway to revise the ETS system to ensure more timely availability of data at local and national levels.
Case numbers reported in ETS system in 2002 exceeded notifications (table 1) for the first time. The apparent decline in cases reported through NOIDS is not uniform across the country and is most likely to be attributable to changes in surveillance practice at local level. In some areas, electronic reporting systems linked to the ETS system have been associated with reduced reporting of cases through NOIDS. In the light of these observations, recent trends in tuberculosis based on NOIDS data should be interpreted with caution. Provisional ETS data for 2002 demonstrate that overall tuberculosis case numbers continue to increase in England and Wales. Further work is being carried out to investigate recent trends in more detail.
Table 1 NOIDS vs ETS national comparison of cases reported from 1999 to 2002
| Year | NOIDS | ETS |
|---|---|---|
| 1999 | 6143 |
5704 |
| 2000 | 6572 |
6271 |
| 2001 | 6714 |
6597 |
| 2002 | 6752 |
6907* |
Figure 1 NOIDS vs ETS national comparison of cases reported by rate per 100, 000 population from 1999 to 2002
An increase in calls to NHS Direct about vomiting and diarrhoea during February/March 2004
During February 2004 there was a gradual increase in the proportions of NHS Direct calls made about vomiting and diarrhoea. This increase accelerated during the first week of March (week 10/04: vomiting increased to 6% of total calls, diarrhoea to 3.8%). Similar rises have occurred at the same time over the last two years. During week 10, the proportions of vomiting calls were 5.1% (2002) and 6% (2003), and diarrhoea 3.9% (2002 and 2003) (figure1).
Figure 1 Proportion of daily vomiting and diarrhoea calls in England and Wales (all ages)
The largest increases in vomiting and diarrhoea calls have been noted for calls made about children aged under five years. For week 10/2004, the proportions of calls about those aged under one year were 17% for vomiting and 12.6% for diarrhoea: for those between aged between one and four years the proportions were 14.9% for vomiting and 7.1% for diarrhoea. These proportions are similar to the equivalent week during 2003, the only year for which there are comparable data.
During the first week of March 2004, statistically significant daily excesses (‘exceedances’) of vomiting calls occurred predominantly at NHS Direct sites in the South and South East of England (figure 2). These increases in the proportions of vomiting and diarrhoea calls coincide with an increase in the reports of norovirus outbreaks from across the country.
Figure 2 Proportion of vomiting calls by NHS Direct site (all ages): week 09/2004
HPA develops faster test to detect tetanus in heroin
The Health Protection Agency has developed a laboratory test that could speed up the process of examining samples of heroin for Clostridium tetani. In trials so far, the new test has enabled detection of C. tetani in heroin samples within hours. This is substantially quicker than conventional laboratory methods, which can take three days.
Faster detection would enable rapid identification of the source of tetanus outbreaks in injecting drug users, so that action could be taken earlier to stop current outbreaks and prevent more people from becoming ill.
The test was developed during the investigation of the ongoing outbreak of tetanus among injecting drug users (1).
References
1.HPA. Ongoing national outbreak of tetanus in injecting drug users. Commun Dis Rep CDR Wkly [serial online] 2004 [cited 11 March 2004]; 14(9): news. Available at <http://wwww.hpa.org.uk/cdr/archives/2004/cdr0904.pdf>.
Dengue fever in Indonesia
The Ministry of Health in Indonesia reported 23,857 cases of dengue fever (including 367 deaths) between 1 January and 3 March 2004 (1). The majority of dengue cases have been reported from the islands of Java (all provinces), south Kalimantan region of Borneo, south Sulawesi, Bali, east and west Nusa Tenggara, and Aceh (northern Sumatra). Den-3 is the predominant serotype circulating, but all four serotypes (Den-1, Den-2, Den-3, and Den-4) are present.
Indonesia has traditionally been a popular destination for British travellers, although at the present time the Foreign and Commonwealth Office in the United Kingdom advises against all non-essential travel to Indonesia, and all travel to Aceh and Poso district in central Sulawesi, due to a high general threat from terrorism in the country. Further information and advice regarding the security situation Indonesia can be found on the FCO website (2).
Travellers who do visit Indonesia, in addition to exercising extreme caution in terms of security, should practise insect bite avoidance during the day, particularly around dawn and dusk, when the Aedes mosquito vector is most active. Information sheets about dengue fever and insect bite avoidance for travellers and health professionals are available from the National Travel Health Network and Centre (NaTHNaC) website (3).
Dengue fever has been endemic in Indonesia since the 17th century, but the more severe form dengue haemorrhagic fever (DHF) was first reported in Surabaya and Jakarta in 1968 (4). Dengue fever tends to occur in cycles and since 1980 large outbreaks have occurred every three or four years according to DengueNet figures (5). In response to this outbreak, the Indonesian Ministry of Health is conducting mosquito control measures with intensive insecticide spraying, and the World Health Organization is assisting with the laboratory diagnosis of disease.
References
1.World Health Organization. Dengue fever in Indonesia - update [online] 5 March 2004. Geneva: WHO, 2004 [cited 9 March 2004]. Available at <http://www.who.int/csr/don/2004_03_05/en/>.
2.Foreign and Commonwealth Office (FCO) website. Travel advice - Indonesia. London: FCO, 27 February 2004 [cited 9 March 2004]. Available at <http://www.fco.gov.uk/servlet/Front?pagename=OpenMarket%2
FXcelerate%2FShowPage&c=Page&cid=1007029390590&a=KCountryAdvice&aid=1013618385558>.
3.The National Travel Health Network and Centre (NaTHNaC) website. London: NaTHNaC, 2003. Available at <http://www.nathnac.org>.
4.World Health Organization South-East Asia Region. Report of an External Review, Jakarta, Indonesia. New Delhi, India: (WHO) South-East Asia Region, 5-19 June 2000 [cited 9 March 2004]. Dengue Bulletin 2000: 24. Available at
<http://w3.whosea.org/>.
5.World Health Organization. DengueNet. Geneva: WHO, 2002. Available at <http://rhone.b3e.jussieu.fr/DengueNet/>.
