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

News Archives 23 February 2006

Last updated: Volume 16, No. 8 (PDF file, 282 KB)

Archives | News Archives 2006: Page 1| News 23 February 2006

News Archives: | 2006 | 2005 | 2004 | 2003

• Avian influenza in Europe and algorithm for management of returning travellers
• Decrease in mumps notifications in England and Wales
• Report of the National Glycopeptide-Resistant Enterococcal Bacteraemia Surveillance Working Group

Avian influenza in Europe and algorithm for management of returning travellers

Highly pathogenic avian influenza infection with the H5N1 virus has now been confirmed in small numbers of wild birds in a number countries within the European Union including France. No outbreaks in poultry and no human cases have been identified in the EU. The situation, however, continues to evolve and further identification of infection in wild birds can be expected.

The HPA algorithm for management of travellers returning from countries affected by avian influenza and presenting with febrile respiratory illness has been updated to reflect the recent developments. It now includes areas of the relevant EU countries. The algorithm also now addresses the possibility of severe unexplained illness occurring in a traveller returning from an area of the world where there has, as yet, been no confirmed report of highly pathogenic avian influenza H5N1 in either wild birds or poultry, but the patient has a history of recent exposure to sick or dead birds. The algorithm still recommends testing people with a compatible illness and a history of exposure to birds in a country/zone with confirmed avian influenza..

The updated algorithm is available on the HPA website at: <http://www.hpa.org.uk/infections/topics_az/influenza/avian/guidelines.htm>.

Decrease in mumps notifications in England and Wales

During 2005, 56,390 cases of mumps were notified in England and Wales. The number of cases started to decline in the second half of the year and there have been 3307 cases notified in the first seven weeks of 2006 (averaging around 470 cases per week compared to more than 1,600 per week in the first six months of 2005) (figure) .

Figure. Notifications of mumps: 200 to 2006

In response to the increased numbers of mumps cases, in February 2005 the Health Protection Agency recommended that oral fluid samples for confirmation of mumps should not be taken from individuals born between 1981 and 1986 (1). In light of the current epidemiology, this temporary suspension has been terminated and from 1 January 2006 the testing of all notified mumps cases has been recommended.

References

1. HPA. Changes in laboratory testing as the increase in mumps cases in England and Wales continues. Commun Dis Rep CDR Wkly [serial online] 2005 [cited 23 February 2006]; 15 (5): news. Available at <http://www.hpa.org.uk/cdr/archives/archive05/News/news0505.htm#mumps>.

Report of the National Glycopeptide-Resistant Enterococcal Bacteraemia Surveillance Working Group

The National Glycopeptide-Resistant Enterococcal Bacteraemia Surveillance Working Group Report to the Department of Health has been published as a supplement to the Journal of Hospital Infection (1). This group was established to examine issues related to surveillance of GRE, in the light of surveillance of bacteraemias caused by glycopeptide-resistant enterococci (GRE) becoming mandatory. It reviewed methods used to identify and test the susceptibility of enterococci to glycopeptides, and made recommendations on the reporting of GRE bacteraemias.

Among the recommendations made in the report are:

• As the mandatory surveillance of glycopeptide-resistant enterococci (GRE) bacteraemias has already started, the report recommends a phased approach to some of the developments, such as using meaningful denominators for the bacteraemia rates.
• Rates of GRE bacteraemias in trusts should not be used as a performance indicator because the numbers are too small for valid analysis in this way.
• GRE bacteraemias as a proportion of all clinically significant bacteraemias in the trust should be measured as an indicator of changing trends.
• Since most GRE are likely to be associated with specialist units, reports of GRE bacteraemia should indicate the specialty in which the patient acquired the infection.
• Data on clinical activity in the special units where patients acquired GRE bacteraemias should be obtained from trusts with more than five GRE bacteraemias in a year.
• The significance of blood cultures containing GRE should be assessed clinically. If the bacteraemia that includes GRE is deemed to be clinically significant (according to the case definitions for bacteraemia), whether mono- or polymicrobial, it should be reported as a GRE bacteraemia.
• Enterococci from blood cultures should be identified to species level to provide data on resistance rates in different species.
• Biochemical identification should be augmented by antimicrobial susceptibility patterns. The identification is suspect if Enterococcus faecalis appears to be ampicillin resistant and/or quinupristin/dalfopristin susceptible, or if Enterococcus faecium appears to be ampicillin susceptible and/or quinupristin/dalfopristin resistant. The identification and susceptibility of such isolates should be checked and, if confirmed, the isolate should be sent to a reference laboratory for further investigation.
• Enterococci from blood cultures should be tested for susceptibility to vancomycin. Teicoplanin is not an acceptable alternative to vancomycin for these purposes.
• Standardized methods should be used for glycopeptide susceptibility testing of enterococci, and the technical requirements of the methods must be adhered to.
• The situation should be reviewed after a year and the methodology should be amended as appropriate.

The full text of the report can be viewed online on the Journal of Hospital Infection webpages <http://www.intl.elsevierhealth.com/journals/jhin/>.

References

1. Brown DFJ, Brown NM, Cookson BD, Duckworth G, Farrington M, French GL, et al. National Glycopeptide-Resistant Enterococcal Bacteraemia Surveillance Working Group Report to the Department of Health – August 2004. J Hosp Infect 2006; 62 (suppl); S1-27. Available at <http://www.intl.elsevierhealth.com/journals/jhin/>.