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Final Issue: Volume 16 Number 51

Published on: 21 December 2006

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News Archives 15 December 2005

Last updated: Volume 15, No. 50 (PDF file, 290 KB)

Archives | News Archives 2006: Page 1| News Archives 2005 Page 2 | News 15 December 2005

News Archives: | 2006 | 2005 | 2004 | 2003

 

 

National increase of Vero-cytotoxin producing E. coli O157 (VTEC O157) PT8 – Update

 

Seventy-two cases of Vero-cytotoxin producing E. coli (VTEC) O157 PT8 have been confirmed by the the Health Protection Agency Laboratory of Enteric Pathogens (LEP) since 1 October 2005 (1). Ten of the 72 cases reported recent foreign travel, 16 were secondary cases and four were asymptomatic cases. Five cases are known to have been hospitalised. No deaths have been reported.

Of the 42 primary cases, 29 shared the same pulsed field gel electrophoresis (PFGE) profile with enzyme XbaI (profile 1). Ten strains had PFGE profiles distinguishable from profile 1; some of these were closely related to profile 1 and further work is in progress to clarify this. Results on three are awaited. The geographical distribution of cases by PFGE profile is shown in Figure 1. The last known onset date is the 28 November 2005 (Figure 2).

Figure 1 Geographical distribution of cases in England and Wales by PFGE profile (N=36)

 

Key: blue dots = profile 1; crosses = not profile type 1

Figure 2 Epidemic curve by PFGE profile (N=37)

 

 

Eight cases were interviewed as part of a hypothesis generating exercise, leaving 23 cases eligible for inclusion in a case control study which began on the 7 December 2005. Cases were defined as residents of England and Wales with E. coli O157 PT8 infection (PFGE profile 1) confirmed by LEP and reported on or after 1 October 2005. Fourteen cases fitting the case definition and 27 controls, matched by age, sex and geographical location, have been included in the study, and data analysis is in progress.

References

1.Health Protection Agency. Increase in Vero cytotoxin-producing Escherichia coli O157 PT8 infections in England . Commun Dis Rep CDR Wkly [serial online] 2004 [cited 15 December 2005]; 14(47): News. Available at <http://www.hpa.org.uk/cdr/archives/2004/cdr4704.pdf>.

 

Hajj 2006: Advice for travellers

The Hajj is a pilgrimage to the Saudi Arabian capital city of Makkah (Mecca); a religious obligation to be performed by all adult Muslims whose health and financial means permit it. It takes place annually between the eighth and thirteenth day of the last month of the Islamic lunar calendar, which is ten days shorter than the Gregorian year. Hajj therefore falls at a different time every year; the next Hajj is expected to take place between 8th and 12th of January 2006 (1).

Over two million Muslims perform the Hajj every year, around 20,000 from the United Kingdom (UK). It is the largest annual international gathering of its kind in the world. There are specific rites and duties that have to be performed as part of the pilgrimage, and these can be strenuous and physically demanding, especially as they are performed in large crowds. The health needs of individuals performing the Hajj are varied and are mainly physical, such as protecting themselves from the sun, heat, and dehydration. There are, however, infection risks associated with the Hajj, especially due to the overcrowded conditions that pilgrims experience. These are mainly respiratory and gastrointestinal infections.

All intending pilgrims should seek pre-travel health advice at least ten days before travelling and obtain the appropriate vaccinations. Travellers from the UK are required to produce valid and up to date proof of receiving meningococcal disease vaccination (ACYW135) in order to obtain a visa to enter Saudi Arabia, This vaccination is valid for three years and should be received not less than ten days before travel.

UK travellers, who may travel elsewhere before arriving in Saudi Arabia, may also require proof of additional vaccinations to enter the country. These are:

 

Travellers arriving from other countries will also be required to have immunisation or treatment at the Saudi Arabian border point:

 

 

Other vaccinations are recommended for travel to Saudi Arabia, such as tetanus, diphtheria, and polio (if no booster of these received within the last ten years), typhoid, hepatitis A, and hepatitis B. Influenza vaccine may also be considered by Hajj pilgrims, but should be received by those pilgrims who fall into the UK criteria for influenza immunisation (4).

Further advice and information about vaccination and other health needs associated with the Hajj can be obtained from the National Travel Health Network and Centre (www.nathnac.org). For more complex itineraries, or for travellers with special health needs, health professionals can call the NaTHNaC advice line, tel: 0845 602 6712 (Monday to Friday, 9am - 12 noon; 2pm - 4.30pm).

References
1. Shafi S, Memish ZA, Gatrad AR, Sheikh A. Hajj 2006: communicable disease and other health risks and current official guidance for pilgrims. Eurosurveillance Wkly [serial online] 5 December 2005 [cited 15 December 2005]; 10(12), Available at <http://www.eurosurveillance.org/ew/2005/051215.asp>.
2. World Health Organization. Revised International Health Regulations (2005). Geneva: World Health Organization; 2005. Available at <http://www.who.int/csr/ihr/en>.
3. World Health Organization. Saudi Arabia requires people aged under 15 years traveling from polio-affected countries to be immunized against the disease. Wkly Epid Rec 2005; 80(33): 288. Available a <http://www.who.int/wer/2005/wer8033.pdf>.
4. World Health Organization. Health conditions for travellers to Saudi Arabia Pilgrimage to Mecca (Hajj). Wkly Epid Rec 2005; 80(49/50/): 431-2. Available at <http://www.who.int/wer/2005/wer8049.pdf>.
5. Department of Health (DH). Flu. Policy and Guidance, DH website [online] 2005 [cited 14 December 2005]. Available at <http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Flu/fs/en>.



First annual report on hepatitis C published

The Health Protection Agency has published its first annual report on hepatitis C in England (1). The report includes chapters on the prevalence of hepatitis C in England, surveillance and research, increasing awareness, the burden of disease, prevention – focusing on injecting drug users (IDUs), and HPA initiatives.


Of the estimated 200,000 individuals in England who have a chronic hepatitis C infection, a proportion will go on to develop severe liver damage. There are currently estimated to be around 4,500 people living with severe liver disease in England and Wales, including cirrhosis, liver failure or liver cancer, as a result of having a chronic hepatitis C infection, a figure that could rise to around 7,000 by 2010. Most individuals with chronic hepatitis C infection can be successfully treated, but the success of treatment relies on people coming forward for testing. To enable this, local health services need to provide clear pathways of referral to enable these patients to access the necessary services and be diagnosed.

Injecting drug use is the dominant driver in the growth of hepatitis C in England, accounting for more than 80% of diagnosed infections. Prevalence of hepatitis C among injecting drug users is high, at around 40% and since 2000 prevalence in recent injectors has doubled to 20%, suggesting a recent increase in transmission.


Laboratory confirmed diagnoses for hepatitis C rose from 6341 in 2003 to 7902 in 2004. This indicates that the rate of diagnoses has risen and therefore that more diagnostic testing is taking place. This could be as a result of the Department of Health's hepatitis C professional awareness raising which began in 2002/2003.

References
1. Health Protection Agency. Hepatitis C in England. The first Health Protection Agency Annual Report 2005. London: HPA, 2005. Available at <http://www.hpa.org.uk/hpa/publications/hepC_2005/default.htm>