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News Archives 13 April 2006

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Archives | News Archives 2006: Page 1| News 13 April 2006

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H5N1 avian influenza swan in Scotland: follow up

Outbreak of measles in Doncaster

Arrangements for reporting MRSA data

H5N1 avian influenza swan in Scotland: follow up

On Thursday 06 April 2006, the Department for the Environment Food and Rural Affairs (Defra) confirmed that a dead swan found lying at Cellardyke, Fife, on the southeast coast of Scotland had died of highly pathogenic avian influenza H5N1. A 3km wild bird protection zone and 10km wild bird surveillance zone were implemented around Cellardyke, and will remain in place for a minimum of 30 days. A larger wild bird risk area was also implemented around the surveillance zone. Results of tests for H5N1 performed as part of enhanced local surveillance in wild birds continue to be made available, but all are negative so far.

The UK's Chief Veterinary Officers announced on Tuesday 11 April 2006 that the bird had been identified as a Whooper swan (Cygnus cygnus) by DNA 'fingerprinting' at the Central Science Laboratory, York. It is believed that the swan originated outside Great Britain, and it is already known that movements of swans associated with cold weather and migration has been a feature of recent developments in avian influenza A/H5N1 in Europe. Whooper swan populations winter across the United Kingdom (UK) and a number of these have been tested over the past few months as part of ongoing routine surveillance: all results so far have been negative. At this time of year Whooper swans leave the UK for their summer breeding grounds. More information is available on the Defra website at < http://www.defra.gov.uk/news/2006/060411a.htm >.

There have been no reports of respiratory illness among State Veterinary Service (SVS) staff responding to the incident in Scotland, or among residents within in the protection or surveillance zones (some 2,200 households). All SVS personnel involved in the response within the 10 km surveillance zone either live locally or are from England and Wales, and lodged temporarily in the Perth area. Those in lodgings returned home on Tuesday 11 April 2006, and new personnel were drafted into the area to continue the response.

There is a very low risk of exposure and an even lower risk of illness to personnel responding to the incident. All incident responders are being advised and monitored on the use of personal protective equipment daily, and have all been advised in writing of the need to report symptoms should they become ill. The HPA is working with Health Protection Scotland, the Scottish Executive, and others to ensure all staff involved are fully supported.

The current level of risk to the general public in the UK remains low: no avian influenza A/H5N1 has been reported in England or in UK poultry. Avian influenza is a disease of birds and although it can pass very rarely and with difficulty to humans, this requires close contact with infected birds. For further information see the World Health Organization website at < http://www.who.int/csr/disease/avian_influenza/en/ >.

Outbreak of measles in Doncaster

Ninety-seven cases of suspected measles from the Doncaster area have been notified to the South Yorkshire Health Protection Unit (SYHPU) since 1 January 2006. To date, 37 cases have been confirmed by laboratory tests (PCR and/or salivary IgM) Twenty-two cases have been negative for both PCR and salivary IgM. Final results are awaited on the remaining cases (figure 1 and 2).

Figure 1 Measles outbreak, notified cases by onset date: 8 January to 8 April 2006

Figure 2 Measles outbreak, notified cases by age of onset: 8 January to 8 April 2006

The first confirmed cases, in week beginning 13 February, were from outbreaks in the local Traveller community, and a playgroup, and an isolated sporadic case. There were no direct links between these three separate incidents, each occurring in geographically distinct areas of Doncaster. A further four cases in travellers were identified retrospectively, linked to the index case. Two of these retrospective cases were resident in Spain but had acquired the illness from contacts in Doncaster. Molecular typing results from six of the early cases from two of the clusters are all the B3 genotype.

Over the following weeks, isolated cases and small family clusters were reported, most of which were unrelated to the playgroup and traveller outbreaks. Around 20% have so far been laboratory confirmed.

PCR testing of throat swabs, urine, and whole blood (preferred minimum of two specimens) was arranged locally, and specimens were forwarded to the Health Protection Agency's Centre for Infections (CfI) for molecular typing. Salivary specimens for IgM testing have been arranged for all community-based cases and for any notified cases with negative PCR results.

SYHPU responded to all notified cases with advice on testing, contact tracing, infection control and protection of susceptibles (as per national guidance) with vaccine and/or human normal immunoglobulin (HNIG). Letters were sent to all schools, nurseries, playgroups and childminders in the district to raise awareness. Briefings were circulated to local PCTs, GP surgeries and hospitals. MMR vaccine was offered to babies aged from 9 months who were close contacts but no changes were made to the routine vaccination schedule for Doncaster children. The outbreak was publicised widely by the local media over several weeks, including television, local radio and newspapers. This was an opportunity to reassure the local community of the safety of the MMR vaccine and to encourage uptake.

The first child to be admitted to hospital was diagnosed as having scarlet fever (a common differential diagnosis), and appropriate infection control measures were not applied. Once the outbreak had been recognised, the hospital introduced a protocol for admitting all suspected cases of measles to prevent nosocomial spread and briefed all clinical staff about measles and the infection control measures required. All children with measles were admitted to a single room staffed by nurses known to be immune. Occupational health screened and/or vaccinated all nursing / medical staff in high risk areas, commencing with paediatric staff. There were four cases of hospital-acquired infection (two confirmed) one in a paediatric nurse and three patients.

There is no evidence of spread within schools. Ninety-five per cent of children in Doncaster have had at least one dose of MMR by their 5th birthday and this appears to have been adequate to prevent school-based outbreaks. There have been three cases of confirmed measles in children who have had a single dose of vaccine but most of the notified cases in vaccinated children have been negative on laboratory testing.

Doncaster normally receives around one notification of measles per month, and prior to these cases, there had been only one case of confirmed measles in a Doncaster resident since routine salivary testing began in October 1994. Although this case had a Doncaster address, they had no contact with Doncaster during the incubation period or while infectious.

This outbreak shows that measles is highly contagious and there is a potential for spread in unvaccinated populations because:

. there is a steadily increasing pool of children with no immunity
. healthcare professionals and parents are unfamiliar with measles
. population mixing, even in pre-school children, is widespread with the potential for dozens of significant contacts before the illness is recognised
. the potential for nosocomial spread is significant and occupational health departments need to ensure that key staff are immune.

Lessons learned locally in this are probably applicable more widely.

Arrangements for reporting MRSA data

A joint letter Reporting MRSA data: overview of arrangements from the Chief Medical Officer and Chief Nursing Officer was published on the Department of Health website on 30 March 2006 (1).

The letter sets out forthcoming changes to arrangements for the collection and checking of the MRSA bacteraemia data returns submitted by NHS acute Trusts. Its contents are for action by Directors of Infection Prevention Control, Infection Control Teams and Medical Microbiologists.

Reference
1. Reporting MRSA data: overview of arrangements PL CMO (2006)2. London: Deprtment of Health, 2006. Available at < http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars
/ProfessionalLetters/ChiefMedicalOfficerLetters/ChiefMedicalOfficerLettersArticle/fs/en?
CONTENT_ID=4132578&chk=9//dnG >.