Final Issue: Volume 16 Number 51	Published on: 21 December 2006	Final Issue in PDF PDF format (283 Kb)

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News Archives: | 2006 | 2005 | 2004 | 2003

• Changes in laboratory testing as the increase in mumps cases in England and Wales continues
• Nationally co-ordinated hepatitis C look-back: England and Scotland

Changes in laboratory testing as the increase in mumps cases in England and Wales continues

The number of national notifications of mumps cases has continued to increase (following a slight reduction over the Christmas period) to between 900 and 1300 cases per week. So far in 2004, 7866 cases of mumps have been confirmed in England and Wales, compared with a total of 3907 cases between 1999 and 2003. Confirmed cases are predominantly in older teenagers and young adults with 79% (6046 cases) reported in people aged between 15 and 24 years.

Since 1995, the Health Protection Agency (HPA) has been offering laboratory confirmation of all notified mumps cases using oral fluid (saliva) samples. The number of notifications and the number of confirmed cases for each quarter since 1995 is shown in figure 1.

Figure 1 Mumps notifications and confirmed cases in England and Wales, by quarter: 1995 to 2004

In the past year the number and proportion of confirmed mumps cases has increased dramatically with an overall confirmation rate of around 60%. As shown in figure 2, the proportion of cases confirmed as IgM positive varies by age with the highest confirmation rates (over 75%) in those born between 1981 and 1986 (ie, aged between 18 and 23 years). False negative results can also occur in a small percentage of cases particularly if the sample is taken early and, therefore, it is likely that virtually all cases in this age range are genuine mumps.

Figure 2 Proportion of positive saliva samples in 2004 by year of birth

On the basis of this, the HPA is recommending that during this period of increased mumps incidence, oral fluid samples should not be taken from individuals with clinical mumps who were born between 1981 and 1986, and that they should be managed as if they were a confirmed case. Samples should continue to be taken from cases in all other age groups or where it is clinically important to confirm the diagnosis (for example, where a complication has been observed).

For further and information on mumps is available on the HPA website at:
<http://www.hpa.org.uk/infections/topics_az/mumps/menu.htm>.

Nationally co-ordinated hepatitis C look-back: England and Scotland

The second phase of a hepatitis C look-back exercise across eight NHS Trusts in England and one Health Board in Scotland has just been completed. It was coordinated by the Health Protection Agency’s Centre for Infections.

In the original exercise in 2003, Kent Health Protection Unit acting on the advice of the UK Advisory Panel for healthcare workers infected with blood-borne viruses (UKAP) conducted a look-back to notify the most recent 500 women who had undergone high-risk exposure-prone procedures (EPP) involving a hepatitis C-infected healthcare worker (HCW). Four hundred and thirty-two women were identified and offered a test for hepatitis C. No positive cases of hepatitis C linked to the HCW were ascertained during this notification exercise. A patient who had undergone an EPP involving the HCW, and who was outside the period restricted to the first phase of the exercise, reported that they were hepatitis C positive. Following further consultation with UKAP, the Panel advised that there was a strong likelihood that the patient acquired their hepatitis C infection from the HCW and recommended that the look-back should be extended to involve all patients who had undergone an EPP involving the HCW.

On 31 January 2005, 2350 patients who underwent high-risk EPPs involving the HCW, and for whom addresses were known, were sent letters explaining the situation and offering them a blood test for hepatitis C. Their general practitioners (GPs) have also been written to. Dedicated help lines offering support to the patients have been set up at each Trust. NHS Direct has also set up a dedicated helpline number to provide advice to people who may be concerned, but have not been informed by the Trust that they should be tested because they were assessed as having no risk of infection even though they received medical care from the HCW. Some patients may have moved from the addresses they were in at the time they received their care and the Trusts do not have current contact details. NHS Direct will provide information for such patients, and details on how they can access the help and support they need.

Information about hepatitis C is also available from the HPA website at:
<http://www.hpa.org.uk/infections/topics_az/hepatitis_c/menu.htm>.

The Department of Health has produced a helpful booklet on hepatitis C: Hepatitis C – Essential information for professionals and guidance on testing. It is available in pdf format at: <http://www.hepc.nhs.uk/resources/documents/HepatitisC_information08.12.04.pdf>.