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News Archives 24 November 2005

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News Archives: | 2006 | 2005 | 2004 | 2003

• HIV and other sexually transmitted infections in the United Kingdom – publication of annual surveillance report Mapping the Issues
• AIDS epidemic update: 25 million have died of AIDS
• Increase in Vero cytotoxin-producing Escherichia coli O157 PT8 infections in England
• Marburg haemorrhagic fever in Angola - outbreak declared over

News Archive

HIV and other sexually transmitted infections in the United Kingdom – publication of annual surveillance report Mapping the Issues

The Health Protection Agency has published Mapping the issues, its annual surveillance report, for HIV and sexually transmitted infections in the United Kingdom (UK) (1). The report describes a worrying situation with undiminished and high levels of transmission of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM), a steady increase in the number of HIV-infected black Africans in the UK, limited but compelling evidence that heterosexual transmission of HIV within the UK is slowly rising, and continuing high transmission of other STIs, (especially chlamydia) among young people. The report summarises current surveillance information on HIV and STIs, as well as some of the behaviours underlying transmission, and shows the distribution of the problem across different areas of the country.

The reports key findings state:

• By the end of 2004 there were an estimated 58,300 (range: 54,700 to 63,400) people living with HIV in the UK, of whom 34% (range: 29% to 39%) were unaware of their infection.
• During 2004 the incidence of HIV infection in MSM remained high at 3% per year. The prevalence of previously undiagnosed HIV infections was 4.7% among MSM attending sentinel genitourinary medicine (GUM) clinics in London and 2.8% among those aged under 25 years. Outside London, the prevalence of previously undiagnosed HIV infection among young MSM attending sentinel GUM clinics was 0.9%.
• The incidence of gonorrhoea also remained high among MSM in 2004, with 3977 infections diagnosed. More than a quarter of gonococcal isolates from MSM in 2004 were shown to be ciprofloxacin resistant, a stark increase from 11% in 2003. In addition, the syphilis epidemic among MSM continued to grow, and there has been a significant rise in the numbers of cases of a previously uncommon disease, lymphogranuloma venereum (LGV).
• Uptake of voluntary confidential HIV testing for HIV among MSM attending GUM clinics increased to 79% in 2004. Of those who could potentially have had their HIV infection diagnosed, 43% remained undiagnosed after leaving the clinic.
• There were 4287 HIV infections newly diagnosed in 2004 which were acquired through heterosexual contact. Of these, 3138 were probably infected in Africa, and the number of these known to have been born in sub-Saharan Africa remained high in 2004, when there was a total of 2315 such diagnoses, little changed from the high number of 2481 diagnoses in 2003. The prevalence of previously undiagnosed HIV infection in heterosexual sub-Saharan Africa born attendees at GUM clinics was 2.7% in London and 7.1% outside London in 2004. Women from Africa are particularly affected, with a prevalence of undiagnosed HIV infection of 8.2% in those attending GUM clinics outside London.
• In England, the overall HIV prevalence among pregnant women who were born in sub-Saharan Africa, was 2.2% in 2004, similar to the 2.4% observed in 2003. Although this prevalence of infection is of concern, the converse is also worth noting: 98% of pregnant women born in sub-Saharan Africa who gave birth to infants in England during 2004 were not infected with HIV.
• The number of diagnoses of HIV infection in people who are thought to have acquired their infection through heterosexual intercourse in the UK continued to rise steadily, from 227 in 2000 to 498 reported so far for 2004 (this number for 2004 will increase as further follow-up is undertaken of cases for which information is incomplete). In heterosexuals born in the UK, attending London GUM clinics, the prevalence of previously undiagnosed HIV infection rose from 0.25% in 2000 to 0.5% in 2004. The prevalence of HIV infection in pregnant women born in the UK increased to 0.07% in 2004, after remaining low and stable at around 0.03% in recent years.
• Young people in the UK are disproportionately affected by chlamydia, gonorrhoea, and genital warts. Rates of STI diagnoses continued to increase among young people in 2004, with the highest rates of gonorrhoea diagnoses seen among men aged from 20 to 24 years (229/100,000) and women aged from 16 to19 (168/100,000).
• In England, rates of gonorrhoea diagnoses were highest in London, 104/100,000 in 2004 and within London, the highest rate was in north central London Strategic Health Authority (SHA) (117/100,000). Outside London, rates were highest in Yorkshire and Humberside (45/100,000), West Midlands (42/100,000), and North West (38/100 000) regions. London also had the highest rates of HIV-infected residents accessing HIV treatment and care services (328/100,000), with all London SHAs seeing an increase over time, but being particularly marked in south east and north east London SHAs. Elsewhere in England, rates of HIV-infected people accessing HIV-related services were highest in Greater Manchester (99/100,000), Surrey and Sussex (97/100,000), Bedfordshire and Hertfordshire (84/100,000) and Thames Valley (72/100,000) SHAs. The resurgence of syphilis in recent years has included a number of localised outbreaks among MSM and heterosexuals in London, Bristol, Manchester, Newcastle-upon-Tyne, Edinburgh, Glasgow, Nottingham, and Northern Ireland, and rates are highest in these areas.
• Rapid access to diagnostic and treatment services for sexually transmitted infections and HIV is a key part of any control programme, and data in the report show that access remains a major problem, with less than half of all GUM clinic attendees being seen within the recommended 48 hours. There is wide regional variation in this access.
• Some prevention initiatives advanced in 2004. Confidential HIV testing rates improved and high numbers of HIV-infected individuals have been maintained on anti-retroviral therapy (ARV). In England, the HIV diagnosis rate among pregnant women increased in 2004; it was estimated that at least 92% of HIV-infected women were diagnosed prior to delivery in England. As a result, the proportion of children exposed to maternal HIV infection who acquire HIV is decreasing. Additionally, in England in 2004, 90% of MSM attending GUM clinics eligible for hepatitis B vaccination received a first dose of vaccine, and roll out of the National Chlamydia Screening Programme was extended.

Mapping the Issues is also accompanied by a series of supplementary data tables and slide sets which can be found with the electronic version of the report at:
<http://www.hpa.org.uk/hpa/publications/hiv_sti_2005>.

References

1. The UK Collaborative Group for HIV and STI Surveillance.. Mapping the issues. HIV and other sexually transmitted infections in the United Kingdom: 2005 London: Health Protection Agency, 24 November 2005. Available at <http://www.hpa.org.uk/hpa/publications/hiv_sti_2005/>.

AIDS epidemic update: 25 million have died of AIDS

A joint report issued in advance of World AIDS Day (1 December) by the United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (1) emphasizes both the increasing scale and impact of the global HIV epidemic, and the importance and potential of interventions in the struggle to reverse these trends.

More than 25 million people have died of AIDS since it was first recognised in 1981, and the report describes the epidemic as one of the most destructive in recorded history. In 2005 alone AIDS has killed over 3 million people, nearly a fifth of whom were children.

At 40.3 million, the number of people living with HIV is also higher than ever. Almost 5 million people are believed to have been infected during 2005. This rising trend in HIV is global, with only the Caribbean seeing no change in overall HIV prevalence.

Two-thirds of all people with HIV live in sub-Saharan Africa. For women the proportion is even higher at 77%. During 2005, 2.4 million people died of HIV-related illnesses in Sub-Saharan Africa, while 3.2 million were newly infected, bringing the total number of people living with HIV in the region to 25.8 million. The most worrying trends are seen in southern Africa, where levels of infection with HIV exceed 20% in six countries, and 30% in two: Botswana and Swaziland. For east Africa the situation is more hopeful. Sustained interventions and behavioural changes are bringing decreased levels of infection in countries such as Uganda and Kenya. HIV prevalence in west and central Africa remains stable.

Outside Africa, there is evidence of emerging epidemics in Asia, Oceania, and eastern Europe. The situation in China continues to grow more serious, while other large Asian countries such as Pakistan and Indonesia are also believed to be on the verge of serious epidemics. In eastern Europe, the number of people living with HIV has risen by a quarter (to 1.6 million) since 2003 and the number of deaths from AIDS has doubled (to 62,000). These new epidemics are associated with injecting drug use and commercial sex. Interventions are urgently needed to focus on these risky behaviours.

Access to antiretroviral treatment remains the most crucial issue in stemming the number of HIV-related deaths. This has improved in recent years and treatment is no longer the preserve of those in wealthy Western countries. Some Latin American countries now boast coverage levels of more than 80%. Access to treatment in Asia and particularly Africa, however, remains very poor. Moreover, the report makes it clear that to bring AIDS under control the underlying factors that fuel the epidemics must be tackled, particularly socio-economic inequalities and issues of human rights.

References

1. UNAIDS/WHO. AIDS epidemic update: December 2005. Geneva: UNAIDS, 2005. Available at <http://www.who.int/hiv/epiupdate2005/en/index.html>.

Increase in Vero cytotoxin-producing Escherichia coli O157 PT8 infections in England

Between 1 October and 15 November 2005 the Health Protection Agency Laboratory of Enteric Pathogens received 47 isolates of Vero cytotoxin-producing E. coli (VTEC) O157 phage type 8 (PT8) associated with human infection in England. This compares with 14 in the same period in 2004. Phage type 8 was the second most common phage type reported in 2004, accounting for 23% of all VTEC isolates (1).

Routine follow-up of cases revealed that 8 reported foreign travel, five were secondary cases and three were asymptomatic. Of the remaining 31 primary cases, 19 were aged under 20 years. Nineteen cases were female, nine male and three were sex unknown. The median age was 14 years (age range: 0 to 75 years). Onset dates were available for 25 cases and ranged from 4 September to 7 November 2005 (figure 1).

Figure 1 Cases of E.coli O157 PT8 infection in England by date of onset of illness (n=25)

Cases were distributed throughout England with reports from each NHS region. To date, no cases have been reported from Wales (figure 2). An Enter-net (2) message was issued on the 18 November 2005 and responses received do not indicate a corresponding increase in this phage type in other European countries.

Eight cases have been interviewed in depth to generate hypotheses about the source of infections. No single outlet, function, contact with animals or recreational water activity were identified. Pulsed field gel electrophoresis (PFGE) is being carried out on a selection of isolates to establish possible links between cases. Further investigations will be carried out to take into account the developing epidemiological and microbiological situation.

Figure 2 Geographical distribution of cases

References

1.HPA. Vero cytotoxin-producing Escherichia coli O157: 2004. Commun Dis Rep CDR Wkly [serial online] 2005 [cited 23 November 2005]; 15(28): enteric. Available at <http://www.hpa.org.uk/cdr/archives/2005/cdr2805.pdf>.

2.IST Fisher on behalf of the Enter-net participants. The Enter-net international surveillance network - how it works. Eurosurveillance [serial online] 1999 [cited 23 November 2005]; 4(5). Available at
<http://www.eurosurveillance.org/em/v04n05/0405-222.asp>.

Marburg haemorrhagic fever in Angola - outbreak declared over

On 7 November 2005, the Angolan health authorities announced that the outbreak of Marburg haemorrhagic fever that had killed hundreds in northern Angola since it began in October 2004 had been officially declared over (1).

The outbreak was confirmed as being caused by Marburg virus in March 2005 and was focused mainly in Uíge province, with a few cases occurring in other nearby provinces such as Cabinda, Luanda, Kuanza Norte, and Zaire (2). All of the cases reported, however, originated from, or were related to cases that had occurred in Uíge province. The epidemic peaked between 28 March and 3 April 2005; there have been no laboratory confirmation of new cases in the country since 27 July 2005. The final number of cases was 252, with 227 deaths, and 25 survivors, representing a case fatality rate (CFR) of 90%. Initial control of the outbreak was hampered by cultural differences between the medical teams and those who were affected by the outbreak, and also by civil unrest that has been occurring in the country over some years. This was overcome by recruiting local religious leaders, social experts, and anthropologists to join the teams with the World Health Organization, the Angolan Ministry of Health, Médecins San Frontières, and other non-governmental agencies, in order to assist with communication to, and education of those affected by the outbreak.

This is the largest outbreak of Marburg haemorrhagic fever reported to date. Previously, the largest outbreak had occurred in the Democratic Republic of the Congo between 1998 and 2000, when 149 cases and 123 deaths (CFR 83%) were reported (3). Despite intensive investigations extending over several years, research has failed to find an animal reservoir of the virus where it may occur between human outbreaks.

References
1. Republic of Angola Embassy in the UK. Marburg disease eradicated [press release] [online] 8 November 2005 [cited 21 November 2005]. Available at <http://www.angola.org.uk/press_release_marburg_off.htm>.
2. Health Protection Agency. Marburg haemorrhagic fever in Angola – update. Commun Dis Rep Wkly [serial online] 2005 [cited 21 November 2005]; 15(14): News. Available at <http://www.hpa.org.uk/cdr/archives/archive05/News/news1405.htm#marburg>.
3. World Health Organization. Marburg virus disease in Angola – update. Disease Outbreak News [online] [cited 23 March 2005] Geneva: WHO, 2005. Available at <http://www.who.int/csr/don/2005_03_23/en/>.