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Vol 16 no 51 |
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Final Issue: Volume 16 Number 51 |
Published on: 21 December 2006 |
Final Issue in PDF |
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News Archives 22 June
Last updated: 22 June 2006 Volume 16, No.25 (PDF file, 270 KB)
Archives | News Archives 2006: Page 1| News 22 June 2006
CDR Home | News
National increase in human Salmonella Montevideo infections in England and Wales: March to June 2006
Between the 1 March and the 19 June 2006, the Health Protection Agency (HPA) Laboratory of Enteric Pathogens (LEP) has received isolates from 45 non-travel associated human cases of Salmonella Montevideo infection in England and Wales fully sensitive to the LEP panel of antimicrobial drugs. During the same time period in 2005, the LEP received 14 isolates of this infection.
The HPA Environmental and Enteric Diseases Department (EEDD) has been liaising closely with HPA Local and Regional Services (LaRS) to gather epidemiological and demographic data on these cases. Information has been received for 34 cases. Reported onset dates for 27 of the 45 cases between 25 February and 24 May 2006 are shown in figure 1.
Figure 1 Epidemic curve (N=27) of human Salmonella Montevideo cases in England and Wales
Of those cases for which information has been received by the HPA's Centre for Infections, over half (22/42; 52%) of the cases are aged under four years. In those aged 4 years or under, one-third (8/22; 36%) are aged 12 months or under. There is no apparent gender difference within all age groups (female 48%, male 52%). With the exception of the North East Region, all HPA regions and Wales are affected (figure 2).
Figure 2. Geographical distribution of cases (N=40)
Molecular typing by pulsed-field gel electrophoresis (PFGE) has identified a putative outbreak strain with a PFGE designation of SmvdX07. The HPA LEP and EEDD are continuing microbiological and epidemiological investigations into this increase.
Please contact Richard Elson (tel: 0208 327 6214 email: richard.elson@hpa.org.uk) with details of suspected cases, or any other information, that may be linked to this national increase.
New emerging norovirus variant
The Virus Reference Department (VRD) at the HPA’s Centre for Infections, has recently reported an increasing proportion of norovirus outbreaks caused by a new variant of the genogroup II.4 [Bristol/1993/UK (Grimsby)] strain of the virus. Capsid sequencing indicates conserved amino acid changes within the virus capsid, which defined this new variant, when compared to other strains of this genotype such as Farmington Hills and Hunter 284 strains, the latter being the most predominant strain until the end of 2005. The new variant was first detected in December 2005. Table 1 shows the number of outbreaks sampled in the UK up to May 2006. In April and May 2006, the proportion of all genogroup II.4 strains that were identified as new variant was 27/93 (29%) and 36/63 (57%) respectively. This new variant has also been reported from The Netherlands, France, and Denmark. In recent weeks, several cruise ship outbreaks have been reported in the UK media and elsewhere in Europe. Outbreak strains from two of the cruise ship outbreaks have been identified as the new variant.
Table Emergence of a new GII -4 variant strain associated with outbreaks of gastroenteritis in the UK in 2006
| 2006 | Total No. OB referred |
Total No. genotyped |
% Typed |
Total GII-4 |
% Type identified as GII-4 |
Total GII-4 variant |
% GII-4 typed as variant |
| January | 184 |
63 |
34.2 |
47 |
74.6 |
4 |
8.5 |
| February | 257 |
63 |
24.5 |
52 |
82.5 |
8 |
15.4 |
| March | 218 |
109 |
50.0 |
94 |
86.2 |
23 |
24.5 |
| April | 208 |
97 |
46.6 |
93 |
95.9 |
27 |
29.0 |
| May | 145 |
68 |
46.9 |
63 |
92.6 |
36 |
57.1 |
The HPA’s Environmental and Enteric Diseases Department (EEDD) and VRD are currently reviewing the epidemiological and microbiological information and trying to find out more about these outbreaks. A notification has been sent out through the Regional Epidemiologists and gastrointestinal illness leads in HPA regions as well as trough the Clinical Virology Network to achieve comparable datasets from 2005 and 2006 to investigate these outbreaks in more detail. The aim is to compare outbreaks caused by the new variant to the outbreaks caused by the other variants. This seasonal pattern is unusual as norovirus outbreaks normally decline by the summer. Unusual seasonal patterns occurring in the past have coincided with the emergence of novel strains [1], further investigations are needed to explore whether this new variant of the genogroup II.4 strain is likely to emerge as the predominant outbreak strain.
References
1.Lopman B, Vennema H, Kohli E, Pothiere P, Sanchez A, Negedro, A, et al. Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of new norovirus variant. Lancet 2004; 363: 682-88.
Essential steps to safe, clean care: reducing healthcare-associated infections
On 15 June 2006, the Department of Health published Essential steps to safe, clean care. It forms part of the delivery programme to reduce healthcare-associated infections and is effectively the adaptation of the Saving Lives: a delivery programme to reduce healthcare associated infection including MRSA to the non-acute healthcare setting.
It provides a framework for organisations in the non-acute sector (for instance, Primary Care Trusts, Mental Health Trusts, Care Homes, GP practices etc.) to assess themselves and identify areas requiring further attention. Tools are provided for this self assessment, for the production of a balanced scorecard, staff certificates etc. It is available at:
Infection control guidance for care homes
The recent publication of Infection control guidance for care homes by the Department of Health updates the guidelines on the Control of Infection in Nursing and Residential Homes, published in 1996. It was produced in association with the Public Health Medicine Environmental Group, The Infection Control Nurses’ association, and Chartered Institute of Environmental Health. It aims to ensure that all reasonable steps are taken to protect residents and staff from acquiring infections in care homes. It provides information and guidance on requirements and recommendations to proprietors and people in charge of homes, and to the Commission for Social Care Inspection (CSCI) on the prevention and control of infection. It is available at:
<http://www.dh.gov.uk/assetRoot/04/13/63/84/04136384.pdf>.
