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News Archives 10 November 2005

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Archives | News Archives 2006: Page 1| News Archives 2005 Page 2 | News 10 November 2005

News Archives: | 2006 | 2005 | 2004 | 2003

• Report published on illness associated with foreign travel
• Hepatitis E acquired in England and Wales
• Health Protection Agency to take over the national chlamydia screening programme
• Update: outbreak of Salmonella Goldcoast infection in tourists returning from Mallorca – United Kingdom
  
  

Report published on illness associated with foreign travel

The Health Protection Agency has published its first annual report on foreign travel-associated illness in England, Wales, and Northern Ireland in partnership with the National Travel Health Network and Centre (NaTHNaC). The report describes trends of infectious illness associated with foreign travel and follows on from the baseline report produced in 2004 (1).

The report shows that foreign travel by UK residents continued to increase in 2003 and further highlights the increasing importance for health professionals to consider whether any case of infection may be associated with foreign travel, and to record a travel history when requesting laboratory investigations or notifying a case of disease.

Gastrointestinal illness remained the most commonly imported infection in 2003, with the majority of cases having travelled to Europe, reflecting travel patterns of UK residents. Infections of Salmonella Typhi and S. Paratyphi associated with foreign travel, showed slight increases compared to 2002, and the majority of these cases were associated with travel to the Indian sub-continent. Only around two-thirds of cases of typhoid and paratyphoid however have information about travel history. Enhanced surveillance of enteric fevers would be beneficial to investigate risk factors within differing population groups and the effectiveness of preventative measures taken.

Reported cases of malaria fell by 11% compared to 2002 but there were still 1722 cases, the majority of which were the potentially fatal falciparum malaria, mainly acquired in sub-Saharan Africa. A large proportion of cases continued to be seen in those visiting friends and relations and in those who took inappropriate or no chemoprophylaxis. More needs to be done to target at-risk groups for the prevention of unnecessary illness.

Travel history information for a large proportion of routinely reported infections still needs to be improved to allow interpretation of trends and a better understanding of travel-associated infections. The threat of international spread of diseases such as pandemic influenza emphasises the importance of good surveillance of travel-associated illness, to detect those that may have public health implications for the UK. Improved information is also required to contribute to the evidence base from which NaTHNaC (http://www.nathnac.org) develops its expert travel health advice, thereby ‘protecting the health of British travellers’.

The report Foreign travel-associated illness, England, Wales, and Northern Ireland – annual report 2005 is available on the HPA website at <http://www.hpa.org.uk/publications/PublicationDisplay.asp?PublicationID=2>.

References

1. Health Protection Agency. Illness in England, Wales, and Northern Ireland associated with foreign travel – a baseline report to 2002. London: HPA; 2004. Available at <http://www.hpa.org.uk/infections/topics_az/travel/baseline.htm>.

Hepatitis E acquired in England and Wales

The Health Protection Agency, in collaboration with the Welsh National Public Health Service, the Veterinary Laboratory Agency and various NHS Hospital trusts has completed a study of the demographic, clinical, and molecular epidemiological characteristics of patients infected by hepatitis E virus (HEV) not associated with travel to HEV-hyperendemic regions (1). Between 1996 and 2003, 186 cases of hepatitis E were serologically diagnosed in the Virus Reference Department of the HPA’s Centre for Infections. Seventeen of these (9%) were not associated with recent travel abroad. Patients were all aged over 55 years (range: 56 to 82 years), Caucasian and predominantly males (76%). Two patients presented with fulminant hepatitis, one of whom died. Sub-genomic nucleotide sequencing studies showed that all were infected by unique HEV strains closely related to HEV infecting British pigs, all of which belong to genotype 3. The findings suggest that hepatitis E is indigenous to England and Wales, patientsfrom this case series tend to belong to a distinct demographic group, the sources of infection are probably multiple, and pigs may be a reservoir.

Following these findings, the Centre for Infections began enhanced surveillance to identify indigenous cases of hepatitis E and investigate possible risk factors for infection. During the first six months of 2005, 181 cases of infection were diagnosed by the Centre for Infections and the West Midlands Public Health Laboratory. Twenty-four of these had not traveled outside the UK prior to their illness, and another 24 were likely to have acquired their infection indigenously. For further information please contact Dilys Morgan in the Centre for Infections (email dilys.morgan@hpa.org.uk).

References

1. Ijaz S, Arnold E, Banks M, Bendall RP, Cramp ME, Cunningham R, et al. Non travel-associated hepatitis E: demographic, clinical and molecular epidemiological characteristics. J Infect Dis 2005; 192(7):1166-72.

Health Protection Agency to take over the national chlamydia screening programme

The Department of Health has announced that the Health Protection Agency (HPA) is to take over the management of the National Chlamydia Screening Programme (NCSP). The aim of the programme is to control chlamydia through early detection and treatment of asymptomatic infection, to reduce onward transmission and to prevent the consequences of untreated infection. Since the programme started in April 2003, over 78,000 screens have been performed with over 8,000 testing positive. The proportion of men screened has increased from 7% in year one to 12.5% in year two. Screening volumes increased from 18,000 in year one of the National Chlamydia Screening Programme to 60,698 in year two – a threefold increase.

There are 26 regional programmes currently in place covering over 25% of Primary Care Trusts, each of which is locally managed by the Chlamydia Screening Office. Further information on the National Chlamydia Screening Programme can be found at <http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Chlamydia>.

Update: outbreak of Salmonella Goldcoast infection in tourists returning from Mallorca – United Kingdom update.

England and Wales

The Health Protection Agency Centre for Infections has reported 98 confirmed cases of Salmonella Goldcoast in England and Wales since the beginning of October 2005. The cumulative total of cases reported to LabBase 2 in 2005 now stands at 101 compared to 18 in the same time period in 2004. At least ten cases have been admtted to hospital (7 in England and 3 in Scotland).

Follow up information is available for 87 cases (89%). Sixty-three cases (72%) reported recent foreign travel and of these, 52 (83%) reported Mallorca as their destination. One case reported visiting Mallorca as part of a cruise. Over half (56%) of these cases are below 4 years of age (range 0 to 76 years). Onset dates ranging between the 26 September and the 17 October 2005 are available for 46 cases reporting travel to Mallorca (figure).

Figure 1 Cases of S . Goldcoast with history of travel to Mallorca. Cases from England, Wales, and Scotland 20 September to 9 November 2005 (n=71)

Scotland

The Scottish Salmonella Reference Laboratory (SSRL) has reported 39 isolates of S. Goldcoast since 12 October 2005. Prior to this date, one isolate was reported from Scotland in 2005. The cases range in age from 0 to 82 years. Twenty of the cases are aged 5 years or younger.

Twenty-eight of cases report recent travel to Mallorca. One other case visited Mallorca as part of a cruise (unrelated to the English case), one case had returned from Italy, two report no recent overseas travel and travel information is not yet available for the remaining cases. Onset dates ranging between 25 September and 11 October 2005 are available for 25 cases reporting travel to Mallorca (figure).

All UK isolates tested are fully sensitive to antibiotics, all have the same pulsed field gel electrophoresis (PFGE) profile GldX2 (SSRL designation) and were to be plasmid free, with the exception of one isolate which contained two plasmids (6.0; 5.4kD). This is the first time this PFGE profile has been seen in the UK.

Seventeen UK cases reporting recent travel to Mallorca were interviewed in depth as part of a hypothesis generating exercise. The majority had stayed in private self catering accommodation. There is no indication of a link between cases and airports or airlines operating from the UK.

Related stories

HPA. Outbreak of Salmonella Goldcoast infections in tourists returning from Mallorca. Commun Dis Rep CDR Wkly [serial online] 2005 [cited 10 November 2005]; 15 (44): news. Available at <http://www.hpa.org.uk/cdr/archives/2005/cdr4405.pdf>