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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.49 (PDF file, 159 KB)
Archives | News Archives 2004: Page 1| News Archives 2005 Page 2 | News 2 December 2004
News Archives: | 2006 | 2005 | 2004 | 2003
Falciparum malaria in travellers who fail to take prophylaxis in endemic areas
There has been a recent increase in the number of cases of potentially fatal Plasmodium falciparum malaria reported in North American and European travellers to the Dominican Republic (DR). Seven cases have been reported in Europe and five from North America.
One of the European cases was a resident of the United Kingdom (UK), who returned on 5 November 2004 from a two week package holiday to Bavaro, just north of Punta Cana on the east coast of the DR [Marie Blaze, UK Malaria Reference Laboratory, personal communication, 1 December 2004]. Another case was from Spain and five cases were from Germany; all of these cases had also travelled to Punta Cana (1).
Two cases (one to Punta Cana and one to San Francisco de Macoris) were reported from the United States (US) (2) and three from Canada [Ron St.John, Health Canada , personal communication, 30 November 2004]. None of the travellers with malaria took chemoprophylaxis. The UK currently recommends chloroquine prophylaxis for travellers to all areas of the Dominican Republic and this is reinforced in the latest update to the UK malaria guidelines (3). As a precautionary measure, the Berlin Institute of Tropical Medicine, the Public Health Agency for Canada and the Centers for Disease Control and Prevention in the US have now amended their malaria advice to include chloroquine prophylaxis for travellers to all areas of the Dominican Republic including tourist resorts on the east coast.
On 4 November 2004, a British man aged 69 years died from falciparum malaria after a seven-day package holiday to The Gambia. He took no prophylaxis despite The Gambia being a highly endemic country for malaria. Between January and August 2004, there have been 14 cases of falciparum malaria reported in travellers to The Gambia, nine of whom took no prophylaxis. A cluster of five falciparum malaria cases, all of whom had failed to take malaria prophylaxis while travelling in The Gambia, was reported in the northwest of England at the end of 2003 (4).
Malaria caused by P. falciparum is a potentially fatal disease that is preventable by insect-bite avoidance measures (5) and the use of chemoprophylaxis. All travellers to malaria endemic countries such as the Dominican Republic and The Gambia, should be advised to take prophylaxis as recommended by the Guidelines for malaria prevention in travellers from the United Kingdom for 2003 (6).
With the Christmas holiday season approaching it is important to ensure that travellers seeking winter sun in malarious locations are given adequate preventive advice. This includes last minute holidays booked over the telephone or on the Internet. Travel companies should remind travellers that they should seek appropriate travel health advice before their departure. Travellers should ideally allow adequate time before their trip to start taking anti-malaria prophylaxis, although if required it is better to start before the flight than not at all.
Specific travel health advice for health professionals about malaria can be obtained from the Malaria Reference Laboratory, tel: 020 7636 3924 or from the National Travel Health Network and Centre, tel: 020 7380 9234.
References
1.Malaria, imported - Europe ex Dominican Republic . Promed 28 November 2004. In ProMed Mail [online]. Boston US: International Society for Infectious Diseases, 27 November 2004 [cited 2 December 2004]. Available at <http://www.promedmail.org>.
2. Centers for Disease Control and Prevention. Outbreak notice: revised recommendations for malaria prophylaxis in Dominican Republic (Released November 24, 2004). Atlanta : CDC, 2004. Available at
<http://www.cdc.gov/travel/other/malaria_dr_2004.htm>.
3. Bradley DJ, Bannister B (on behalf of the Health Protection Agency Advisory Committee on Malaria Prevention for UK Travellers) . Update to the Guidelines for malaria prevention in travellers from the United Kingdom for 2003 HPA [online]. London: 2004 . Available at <http://www.hpa.org.uk/infections/topics_az/malaria/guidelines.htm>.
4. Bradley DJ, Lawrence J, Hart E. Consequences of failure to use malaria prophylaxis in The Gambia: an example from the United Kingdom . Eurosurveillance Weekly 2003; 7(49). Available at
<http://www.eurosurveillance.org/ew/2003/031204.asp#2>.
5. Bradley DJ, Bannister B (on behalf of the Health Protection Agency Advisory Committee on Malaria Prevention for UK Travellers) . Guidelines for malaria prevention in travellers from the United Kingdom for 2003. Commun Dis Pulic Health 2003; 6(3): 180-99.
Update on national outbreak of Salmonella Newport infection
The outbreak of Salmonella enterica serovar Newport affecting England, Scotland, Northern Ireland, and the Isle of Man previously reported in CDR Weekly (1,2) is thought to be over. Cases continue to be confirmed by the Health Protection Agency's Laboratory of Enteric Pathogens, but disease incidence has returned to background levels (figure).
Figure National outbreak of S . Newport infection, England and Northern Ireland: 2004
Since 9 September 2004, 677 cases of S. Newport infection in England and in Northern Ireland have been reported. Molecular typing performed on 350 of the isolates show that 297 of the strains are indistinguishable from each other.
Case-control studies undertaken locally in north east Lincolnshire and Northern Ireland found that consumption of lettuce was associated with being a case of S .Newport infection. A similar case-control study undertaken in the West Midlands failed to identify a vehicle of infection, possibly due to the small number of controls recruited into the study (26 cases and 12 controls). A pooled analysis of data is underway.
Extensive local environmental investigations identified a number of potential links between suppliers of lettuce to premises implicated in the outbreaks. It has not been possible, however, to trace supply chains back to a single source or to a country of origin. Various food and environmental samples tested negative, possibly reflecting the short shelf life of the implicated vehicle of infection.
References
1. HPA . Update - Outbreak of Salmonella Newport infection in England, Scotland, and Northern Ireland : association with the consumption of lettuce. Commun Dis Rep CDR Wkly [serial online] 2004 [cited 2 December 2004]; 14 (41): News. Available at <http://wwww.hpa.org.uk/cdr/archives/2004/cdr4104.pdf>.
2. HPA. National outbreak of Salmonella Newport infection, England , and Northern Ireland . Commun Dis Rep CDR Wkly [serial online] 2004 [cited 2 December 2004]; 14 (38): News. Available at <http://wwww.hpa.org.uk/cdr/archives/2004/cdr3804.pdf>.
Update from the National Chlamydia Screening Programme in England
As a part of the wider sexual health strategy, the Health Protection Agency (HPA) has worked in close collaboration with the Department of Health (DH) to facilitate the phased implementation of the National Chlamydia Screening Programme (NCSP) in England . The programme focuses on provision of chlamydia screening outside genitourinary medicine (GUM) clinics with active patient treatment and partner follow-up by local chlamydia screening teams.
The programme is now established in 82 primary care trusts through two phases from September 2002. Recently, the DH and HPA jointly sponsored the first annual chlamydia screening programme conference to highlight the results of the first year.
These results are included in two recent publications:
(i) The First Steps. annual report of the National Chlamydia Screening Programme in England, 2003/04 produced collaboratively by the DH and HPA and provides an excellent overview of the programme components and structure, and implementation process for the first phase. It also includes results from screening, patient management, and partner contact tracing activities (1).
(ii) Establishing the National Chlamydia Screening Programme in England : results from the first full year of screening, published in the journal of Sexually Transmitted Infections in October 2004. This paper includes detailed epidemiologic analysis of the opportunistic screening data among young men and women (2).
These early results indicate that opportunistic screening for chlamydial infection outside of GUM clinics is feasible, and successful treatment provision to patients testing positive and their partners can occur. The disease burden within the young adult population is also quite high: 10.1% of women and 13.1% of men aged under 25 years opportunistically screened tested positive for the infection. This is similar to the levels of disease found in the original pilot of opportunistic screening in England (from September 1999 to August 2000) (3). The programme also demonstrated that 98% of people screened received treatment with a 76% effective partner treatment rate (1).
The need to improve the sexual health of the population was recently highlighted in the White Paper on public health (4). The Health secretary announced a further £300 million to modernise sexual health services across England . This announcement comes at a time when recent statistics from the HPA indicate continuing deterioration of the sexual health of young people through increased rates of STIs (5). The increase is particularly notable for genital chlamydial infection where there has been steady progression of increased rates of diagnosed cases from genitourinary medicine clinics since 1995 (5). Chlamydia infection is particularly devastating to women, as untreated infection can cause pelvic inflammatory disease (PID), which is a major contributor to ectopic pregnancy and infertility.
The recent government announcement for increased funding and commitment , in Choosing Health (4) , and subsequent announcements to full national coverage of the chlamydia screening programme by March 2007 is a positive development for enhanced disease control and stemming the tide of increasing infections among young people throughout England.
References
1. Department of Health. The first steps.annual report of the National Chlamydia Screening Programme in England , 2003/04 . London: Department of Health; November 2004. Available at
<http://www.dh.gov.uk/assetRoot/04/09/24/61/04092461.pdf>.
2.Fenton KA, H Ward. Establishing the National Chlamydia Screening Programme in England : results from the first full year of screening. Sex Transm Infect 2004 Oct; 80(5): 335. Available at
<http://sti.bmjjournals.com/cgi/content/full/80/5/335>.
3. Pimenta JM, Catchpole M, Rogers PA, Hopwood J, Randall S, Mallinson H, et al . Opportunistic screening for genital chlamydial infection II: prevalence among healthcare attenders, outcome, and evaluation of positive cases. Sex Transm Infect 2003; 79 (1):22-7. Available at <http://sti.bmjjournals.com/cgi/content/full/79/1/22>.
4. Department of Health. Chosing health: making healthier choices easier . London: Department of Health, 2004. Available at <http://www.dh.gov.uk/PublicationsAndStatistics/Publications/fs/en>.
5. Health Protection Agency, SCIEH, ISD, National Public Health Service for Wales , CDSC Northern Ireland , and UASSG. Focus on prevention. HIV and other sexually transmitted infections in the United Kingdom in 2003. London: Health Protection Agency, November 2004. Available at
<http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/publications/annual2004/annual2004.htm>.
Zoonoses report 2003 published by DEFRA
The Department for Environment, Food and Rural Affairs (DEFRA) has published the latest Annual report on zoonoses for the UK, Zoonoses Report UK 2003. The Report draws together information on zoonoses from many sources and gives information in the situation in man, food, and animals, and focuses on major foodborne and waterborne zoonoses, notifiable zoonotic diseases of animals, and other zoonoses. It has been produced by DEFRA in conjunction with the devolved administrations, the Veterinary Laboratory Agencies, Scottish Agricultural College , Scottish Centre for Infection and Environmental Health, Health Protection Agency, Welsh Assembly Government, Food Standards Agency, the Department of Agriculture and Rural Development Northern Ireland, and the Departments of Health of the United Kingdom (UK).
Some highlights include a continued fall in the number of reports of Campylobacter species, with around 49,050 reports in the United Kingdom (UK) in 2003 compared with a peak of just over 65,000 in 1998. The ratio of infection in the community to reports to national surveillance for Campylobacter spp is estimated to be approximately 8:1 (1). This means that in 2003, there were nearly 400,000 campylobacter cases in the community. The overall number of salmonella infections in humans continues to decline, despite an increase in non-phage type 4 Salmonella Enteritidis in all parts of the UK , accounting for a slight increase in total S . Enteritidis reports overall. The incidence of Salmonella Typhimurium increased slightly in England and Wales , resulting in an overall increase in reports of S . Typhimurium in the UK .
Between 2002 and 2003, there was a small increase in the number of human cases of Vero cytotoxin-producing E. coli (VTEC) 0157 in Northern Ireland , and England , Wales and a decrease in the number in Scotland . In 2003, 874 laboratory-confirmed cases of VTEC O157 infection were reported in the UK , a slight increase from the number of confirmed reports in 2002 (852). Until 1995 there was a rising trend in the number of cases of VTEC O157 reported throughout the UK . Since then, however, the number of reported cases has stabilised at approximately 1000 cases per year.
The number of reported cases of cryptosporidiosis in the UK rose from 3663 in 2002 to 6626 in 2003, although this is still less than the 7083 cases in 2000. The number of cases of bovine spongiform encephalopathy (BSE) confirmed in cattle in Great Britain continued to fall, with 547 cases confirmed in 2003, compared with 1039 in 2002.
Zoonoses are defined by the World Health Organization (WHO), as 'diseases and infections which are transmitted naturally between vertebrate animals and man'. They cover a broad range of diseases with different clinical and epidemiological features, with varying control measures because the causative organism may be bacterial, fungal, protozoal, parasitic, viral, or any other communicable agent (for example, prions).
Further information can be found in the report, which can be found on the DEFRA website at
<http://www.defra.gov.uk/animalh/diseases/zoonoses/reports.htm>.
References
1.
