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

News Archives 27 July 2006

Last updated: 27 July 2006 Volume 16, No.30 (PDF file , 377 KB)

Archives | News Archives 2006: Page 1| News 27 July 2006

CDR Home | News

 

• Lassa fever in Germany: follow up of possible contacts
• Annual report on mandatory surveillance of healthcare associated infection
• Healthcare Commission report on investigation into outbreaks of Clostridium difficile at Stoke Mandeville Hospital
• Draft code of practice for the prevention and control of healthcare associated infection
• Q fever in Forth Valley meat processing plant, Scotland
• Salmonella Enteritidis phage type 13a associated with attendees of a charity event
  

Lassa fever in Germany: follow up of possible contacts

 

On July 20 2006, a patient who travelled from Freetown (Sierra Leone) to Germany via Abidjan (Ivory Coast) and Brussels on 10/11 July was diagnosed with Lassa fever. The patient had a history of a progressive neurological condition over several months in Sierra Leone but on 5 July they developed a fever with worsening neurological symptoms. On arrival in Germany the patient was taken to a local hospital and is still under specialist medical care. Health officials in Germany have taken the appropriate measures to prevent further transmission of the virus.

Although the risk of fellow passengers contracting Lassa fever from this patient is very small, officials in European Union countries are contacting individuals to ensure they are aware of the situation.

The relevant flight details are:

• SN Brussels Airlines flight SN 0207 on 10 July from Freetown (Sierra Leone) via Abidjan (Cote d’Ivoire) to Brussels (Belgium): seat rows 23 to 29
• SN Brussels Airlines flight SN 2607 on 11 July, which departed Brussels (Belgium) to Frankfurt (Germany) at 0630: all seats

The contact details of a few passengers on these flights cannot be obtained, but it is thought that the risks of importing infection into the United Kingdom are likely to be remote. The infection is not easily spread and then only by direct contact with bodily fluids. Anyone who has not had direct contact with the patient’s bodily fluids is therefore not at risk. Although the usual incubation period of seven to ten days has passed, a range of up to 21 days has been reported. Therefore, contacts and passengers on the flight are being followed-up until 2 August after which they are considered not to be at risk of developing the disease. Anyone who travelled on one of these flights and who develops fever up until 2 August 2006, should seek medical attention.

Further information is available on the Chief Medical Officer’s public health link at <http://www.info.doh.gov.uk/doh/embroadcast.nsf/vwDiscussionAll/0296308951A0EC6
E802571B8002C3FE7>.
Information on Lassa fever and other viral haemorrhagic fevers can be found on the Health Protection Agency website at <http://www.hpa.org.uk/infections/topics_az/VHF/menu.htm>.

 

Annual report on mandatory surveillance of healthcare associated infection

The annual report on Mandatory Surveillance of Healthcare Associated Infection (HCAI) was published on 24 July [1]. The annual report on Mandatory Surveillance of HCAI encompasses four reports in one. For the first time, the reports on methicillin-resistant Staphylococcus aureus (MRSA) and glycopeptide-resistant enterococci (GRE) bacteraemia, C.difficile infection, and orthopaedic surgical site infection (SSI) surveillance have been published together. The reports provide the most recent data and also update the tables of named Trust numbers and rates of infection since the beginning of the individual surveillance systems. Named Trust data are not provided for orthopaedic SSI surveillance as the timing does not allow publication of the second year’s data yet.

The report also includes the first results from the enhancements to MRSA bacteraemia surveillance, which were implemented last October, and results from the random sampling scheme of C.difficile isolates from Trusts. In addition, a new Trust categorisation has been adopted, utilising that used by the Healthcare Commission, which classifies Trusts by size and, to some extent, case mix, thus enabling better comparisons than the previous categorisation by specialist, general acute, and single specialty Trusts.

Key findings

Results of the fifth year of mandatory surveillance of MRSA bacteraemia, including data from the new enhanced surveillance scheme:

 

• There were sizeable annual increases in MRSA bacteraemia reports up to 2003/04. Since then there have been two annual decreases.
• There were just over 3500 MRSA bacteraemia episodes reported during the period October 2005 to March 2006. This marks a slight fall in the numbers of bacteraemia against the previous year, but it would be premature to state that this indicates the beginning of a downturn in trend.
• The age distribution shows that the largest volume of MRSA bacteraemia are in the elderly, 69% occurring in the 65 years and over age group.
• Numbers of MRSA bacteraemia by trust in the six months from October 2005 to March 2006 varied between 0 and 81. The average number was 20 and the median 16. Six trusts reported no MRSA bacteraemia.
• Acute specialist and acute teaching trusts have contributed significantly to reductions in MRSA bacteraemia. In contrast, marked fluctuations or slight increases have been seen in the aggregate figures for trusts in the other categories between 2003 and 2006.
• Among the government office regions, London region remains the region with the highest numbers overall, despite large decreases. A second region, Yorkshire and the Humber, now has significant decreases in MRSA bacteraemia. Elsewhere, there were less marked changes, except in the North West region where the trend shows a significant increase. This is attributed to improvements in ascertainment and auditing laboratory reporting.
• Analysis of the date of detection of the MRSA bacteraemia in relation to the date of admission showed that the largest proportion of MRSA bacteraemia (67%) was detected after the second day of admission. The finding that 25% were detected on the day of admission or the day after is the subject of further investigation in an attempt to establish the risk-factors for these cases. The remaining 8% of MRSA bacteraemia cases were detected in patients not admitted at the time of blood culture.
• Many bacteraemia are detected after the patient has been in hospital for some considerable time; 25% of MRSA bacteraemia were detected after the 24th day of admission.
• The majority of patients with MRSA bacteraemia were admitted to general medical, general surgical, or care of the elderly wards. Among MRSA bacteraemia patients, 15% were in intensive care or a high dependency ward when their bacteraemia was detected. Eight per cent of renal patients had MRSA bacteraemia.

 

Mandatory surveillance of C. difficile associated disease 2005:

 

• This report describes results from the second year of the mandatory C. difficile case reporting scheme in England. It also includes the data from the first year of the random sampling scheme, whereby strains from individual trusts are characterised.
• Reports were received from all 169 acute trusts treating adult patients in England, an improvement on 2004.
• There were 51,690 reports of C. difficile disease in people aged 65 years and over in 2005, a 17.2% increase on 2004.
• Winter seasonality (highest numbers of reports between January and March and October and December) was not as pronounced as in 2004.
• There is some indication that the numbers of case reports have decreased over the four quarters of 2005. It is too early to assess the causes of this apparent trend.
• Rates are highest in small acute trusts.
• The predominant strain in referrals to the Health Protection Agency’s Anaerobic Reference Laboratory prior to the random sampling scheme was type 001. Non-001 types, however, predominate in the random sampling scheme, specifically types 106 and 027.
• The epidemiological and clinical significance of these findings remain unclear, as research has not yet shown a predictable relationship between type 027 and clinical severity.

 

The second year of mandatory glycopeptide-resistant enterococcal bacteraemia surveillance: October 2004 to September 2005:

 

• This report covers the second year of the mandatory surveillance of glycopeptide resistant enterococcal (GRE) bacteraemia, from October 2004 to September 2005.
• The number of reports are small: 757 bacteraemia compared to 628 in the first year’s report.
• Fifty-four trusts had no cases and only 21 trusts had more than ten cases.
• Two-thirds of cases occurred in specialist trusts.
• These bacteraemia were concentrated in London.

 

Mandatory surveillance of surgical site infection in orthopaedic surgery: report of data collected between April 2004 and December 2005:

 

• The Surgical Site Infection (SSI) report provides important data for both doctors/clinicians and patients about the risk of wound infection following surgery that can be used to inform and improve practice to reduce the risk of infection [2]. In addition, this surveillance also contributes to tackling rates of MRSA, as SSI is a major cause of S. aureus infections and many are caused by MRSA .
• Data have been collected on 79,120 procedures by 155 NHS Trusts between April 2004 and December 2005.
• In most Trusts the rates of SSI in orthopaedic surgery are low, but increase with the number of risk-factors present in the patient.
• Rates of SSI are highest in hip hemiarthroplasty. This is partly explained by patients undergoing these procedures being at greater risk of infection and because they tend to have a longer post-operative stay in hospital, increasing the chance that SSIs will be detected.
• Most of the SSIs reported affected the superficial layers of the wound, but approximately a quarter involved the deeper tissues.
• Staphylococcus aureus is recognised as a major cause of SSI and was responsible for half of the infections. Nearly a third of SSIs were due to MRSA.
  

 

References

1. HPA. Mandatory Surveillance of Healthcare Associated Infection Report, 2006. London: HPA, July 2006. Available at: <http://www.hpa.org.uk/infections/topics_az/hai/mandatory_report_2006.htm>.

2. Department of Health. Winning ways: working together to reduce healthcare associated infection in England. A report by the Chief Medical Officer. London: Department of Health, 2003.

 

Healthcare Commission report on investigation into outbreaks of Clostridium difficile at Stoke Mandeville Hospital

On 24 July the Healthcare Commission published its report of the investigation into two Clostridium difficile outbreaks at Stoke Mandeville Hospital [1]. Overall, 334 patients contracted the infection and at least 33 people died in the outbreaks, which took place between October 2003 and June 2005. These patients had acquired the infection while being treated in hospital. The Healthcare Commission carried out the investigation at the request of the Secretary of State for Health.

References
1. Healthcare Commission. Investigation into outbreaks of Clostridium difficile at Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust. London: Healthcare Commission, July 2006. Available at

<http://www.healthcarecommission.org.uk/newsandevents/pressreleases.cfm?
cit_id=4178&FAArea1=customWidgets.content_view_1&usecache=false>.

 

Draft code of practice for the prevention and control of healthcare associated infection

The draft Code of practice for prevention and control of healthcare associated infections was published by the Department of Health website this week. The Code is designed to help NHS bodies plan and implement how they can prevent and control healthcare associated infections (HCAI). It sets out criteria by which managers of NHS organisations and other health care providers should ensure that patients are cared for in a clean environment, where the risk of HCAI is kept as low as possible. The Healthcare Commission will be using this code to assess NHS performance and similar requirements will be introduced for the private and voluntary healthcare sector and care homes. The final version will be published in autumn 2006.

References

1. Department of Health. Draft code of practice for the prevention and control of healthcare associated infection. London: Department of Health, 24 July 2006. Available at:

http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance
/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4137288&chk=1O%2BE%2Bp

 

Q fever in Forth Valley meat processing plant, Scotland

On 9 July the Public Health Department of NHS Forth Valley became aware of an increase in a flu-like illness in people who worked at a meat processing company in Bridge of Allan, Stirlingshire, Scotland [1]. Blood tests have now confirmed that the illness is Q fever and, as of 24 July, there have been 24 confirmed cases. Although cases are not expected among people who do not work at the plant, there is a small theoretical risk of contracting Q fever by air-borne spread within a half mile radius of the plant. Control measures have been put in place and investigations continue.

Q fever is an uncommon zoonotic infection caused by an organism called Coxiella burnetii. In the United Kingdom, the organism is most commonly found in infected farm animals, especially sheep, cattle and goats, but may also be found in cats and wild animal species such as birds, rodents or bats. Transmission of Coxiella burnetii occurs primarily through inhalation of aerosols contaminated with faeces or urine or from direct contact with infected animals or their products of conception. It may also be acquired from drinking unpasteurised milk. It is extremely rare for the infection to be passed from person to person. The infective dose can be as low as one organism, and so large outbreaks can be caused by a small source.

Human infection is divided into acute and chronic Q fever, although several distinct syndromes have been described . Usually symptoms occur two or three weeks after exposure (range 9 to 40 days) and illness is typically self limiting and influenza-like, with:

 

• Fever (high temperature)
• Headache
• Muscle pains
• Fatigue
• Dry cough (some people may develop pneumonia)

 

Full recovery generally occurs even without treatment but in some cases symptoms can be serious or prolonged, especially with pneumonia or pre-existing valvular disease which may require hospital admission.

References
1. Health Protection Scotland. Q fever in Forth Valley meat processing plant. HPS Weekly News 2006; 40(29). Available at <http://www.ewr.hps.scot.nhs.uk/documents/ewr/pdf2006/0629.pdf>.

 

Salmonella Enteritidis phage type 13a associated with attendees of a charity event

Twenty-one cases of Salmonella Enteritidis phage type 13a have been identified among attendees of an outdoor charity event which was held in Hertsmere, Hertfordshire, on 18 June 2006.

After reports of illness among attendees were received, an investigation led by Hertsmere Borough Council, the London borough of Barnet, Bedfordshire and Hertfordshire Health Protection Unit, and the East of England Regional Epidemiology Office of the Health Protection Agency was started.

About 600 people (mostly children) attended this outdoor charity event which took place during 18 June 2006. The event consisted of two sessions of team games played by children. Those who attended lived in Hertfordshire or north London.

Food was served at the event. This included bread rolls with various fillings including egg, prepared by a caterer. At least 65 attendees are known to have developed illness after the event.

Twenty-seven cases of salmonella have been identified among the attendees and 21 of these cases have Salmonella Enteritidis phage type 13a. Inspections have been made by Environmental Health Officers to the site of the venue and to the premises of the supplier of the filled bread rolls. Investigations are continuing and a case-control study is being conducted.