 |
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.16 (PDF file, 546 KB)
Archives | News Archives 2004: Page 1| News 16 April 2004
News Archives: | 2006 | 2005 | 2004 | 2003
First year of the enhanced surveillance of invasive group A streptococcal infections
Preliminary results from the first year of the enhanced surveillance of invasive group A streptococcal infections in the United Kingdom (UK) illustrate the success in increasing case ascertainment, with reports of group A streptococcal (GAS) bacteraemia having doubled between 2002 and 2003. Initial analysis of reports received thus far indicate a possible 2085 severe group A streptococcal infections in 2003 across England, Wales, Northern Ireland, and the Channel Islands (1). Fifty-five per cent of the cases were male. To date, questionnaires have been received and entered into the database for 60% of cases, and isolates submitted for 77% of cases. Analysis of information available through questionnaires and routine sources indicate that 90% of cases presented with bacteraemia, with or without a primary focus of infection. Among cases for which a specific diagnosis was available 10% presented with septic arthritis, 9% with pneumonia, 6% with toxic shock-like syndrome, 5% with necrotising fasciitis, 3% with puerperal sepsis, and just over 1% with meningitis. One in five of the cases were reported as having died within seven days of initial diagnosis, broadly in line with the previous enhanced surveillance period (1994 to 1997) where the overall mortality rate was 27% (2).
The Health Protection Agency Streptococcus and Diphtheria Reference Unit (SDRU) has so far typed GAS isolates from 1443 blood cultures of specimens taken between 1 January and 31 December 2003, with an overall typability rate of 83% using conventional serological methods. The four predominant serotypes were M1, M3, M87 and M89 (figure 1). The non-typable isolates are currently being further characterised by sequencing of the emm gene. The emergence of higher types during this surveillance period contrasts with the type distributions observed during the 1994-1997 enhanced surveillance, where M1, M3, R28, and M12 predominated (3).
Figure 1 M type distribution of group A streptococcal blood culture isolates submitted to SDRU for typing, January to December 2003
The enhanced surveillance of invasive group A streptococcal infections currently underway in the UK is a major component of the European Commission, Fifth Framework Programme (QLK2.CT-2002-01398) on 'Severe Streptococcus pyogenes disease in Europe', (Strep-EURO) (4). The main aims are to determine and compare the overall disease burden, type distributions and antimicrobial susceptibility patterns of isolates and clinical manifestations of severe group A streptococcal disease across 11 European countries. The UK enhanced surveillance is a joint collaboration between the HPA Respiratory and Systemic Infection Laboratory and the Healthcare Associated Infections and Antimicrobial Resistance Department and commenced on 1 January 2003 for a period of two years (5).
To maximise case ascertainment, data on isolate referrals to the national reference laboratory (SDRU have been merged with routine laboratory reports made to the Communicable Disease Surveillance Centre (CDSC) through the creation of a 'satellite' database. Microbiologists reporting cases through routine reporting methods or submitting isolates to SDRU are sent a survey questionnaire asking for further information. Cases are defined by the isolation of group A Streptococcus from a site that is normally sterile (blood, cerebrospinal fluid, joint aspirates, abscesses, pericardial/peritoneal fluid, deep tissue at operation or necropsy, and bone).
Microbiologists are requested to complete any outstanding questionnaires and to continue to submit all sterile-site group A streptococcal isolates to SDRU.
Further details, including the enhanced surveillance questionnaire, can be found on the HPA strep-EURO web page at <http://www.hpa.org.uk/hpa/inter/strep-EURO.htm>.
Illness in England, Wales, and Northern Ireland associated with foreign travel
Recently published data show that antibiotic prescribing in England for children by general practitioners decreased by 47% over the decade 1993 to 2002 (from 12.4 million to 6.5 million items per annum) (1). This represented a much greater fall in prescribing in children than for the whole population. On average, around 1330 and 710 items were dispensed per 1000 children aged under 14 years in 1993 and 2002 respectively. The cause of this sharp fall is unclear. Use of the three most used antibiotics for children - amoxicillin, erythromycin, and phenoxymethylpenicillin - reduced by 42%, 62%, and 47% respectively. Ampicillin and co-trimoxazole use both reduced by over 95% whereas use of flucloxacillin markedly increased by 114%. These encouraging data were made public at the annual scientific meeting of the Royal College of Paediatrics and Child Health by authors from the Prescription Pricing Authority and St George's Hospital London, reporting a study undertaken for the National Specialist Advisory Committee for Antimicrobial Resistance.
References
1.Kendall HE, Holdsworth S, Sharland M. GP antibiotic prescribing for children in England has halved in the past decade. Arch Dis Childhood (Abstract) Conference Proceedings 8th RCPCH Spring Meeting 29 March-1 April 2004, University of York. Available at <http://adc.bmjjournals.com/content/vol89/suppl_1/>.
Summary guidance (algorithm) for the identification of possible cases of SARS and avian influenza
The Health Protection Agency has published an algorithm on the HPA website to assist in the recognition of possible SARS and avian influenza in patients presenting with unexplained respiratory illness. The algorithm summarises the clinical and epidemiological assessment, infection control measures, and appropriate sampling and reporting mechanisms clinicians should undertake when considering a diagnosis of SARS or avian influenza.
As this constitutes interim guidance, comments are welcomed from clinicians who gain experiencing in using the algorithm, to assist its future development. Contact details are included in the text, which can be found at:
<http://www.hpa.org.uk/infections/topics_az/avianinfluenza/guidelines.htm>.
Additional guidance for SARS and avian influenza can be found on the website at:
<http://www.hpa.org.uk/infections/topics_az/avianinfluenza/menu.htm> and
<http://www.hpa.org.uk/infections/topics_az/SARS/menu.htm>.
Recently published documents include the HPA contingency plan for SARS, and guidance for hospitals on the clinical management of SARS that was drafted by the British Thoracic Society in consultation with the HPA.
Please note that information and guidance are maintained in accordance with the current levels of SARS and human cases of avian influenza reported worldwide. These levels are constantly monitored by the HPA.
Fall in antibiotic prescribing for children
Recently published data show that antibiotic prescribing in England for children by general practitioners decreased by 47% over the decade 1993 to 2002 (from 12.4 million to 6.5 million items per annum) (1). This represented a much greater fall in prescribing in children than for the whole population. On average, around 1330 and 710 items were dispensed per 1000 children aged under 14 years in 1993 and 2002 respectively. The cause of this sharp fall is unclear. Use of the three most used antibiotics for children - amoxicillin, erythromycin, and phenoxymethylpenicillin - reduced by 42%, 62%, and 47% respectively. Ampicillin and co-trimoxazole use both reduced by over 95% whereas use of flucloxacillin markedly increased by 114%. These encouraging data were made public at the annual scientific meeting of the Royal College of Paediatrics and Child Health by authors from the Prescription Pricing Authority and St George's Hospital London, reporting a study undertaken for the National Specialist Advisory Committee for Antimicrobial Resistance.
References
1.Kendall HE, Holdsworth S, Sharland M. GP antibiotic prescribing for children in England has halved in the past decade. Arch Dis Childhood (Abstract) Conference Proceedings 8th RCPCH Spring Meeting 29 March-1 April 2004, University of York. Available at <http://adc.bmjjournals.com/content/vol89/suppl_1/>.
