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

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Last updated: 16 November Volume 16, No.46 (PDF file, 391 KB) Next update: 16 November 2006

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• National increase in cases of legionnaires’ disease – update
  
• New frontiers – annual report of the National Chlamydia Screening Programme in England 2005/6
  

National increase in cases of legionnaires’ disease – update

The rise in the number of recent cases of legionnaires’ disease reported to the Health Protection Agency [1,2] is continuing. By 6 November, 319 cases had been reported to the National Surveillance Scheme for Legionnaires’ Disease in residents of England and Wales with onset of illness since 1 August. One hundred and twenty-nine of these cases are known or assumed (on the basis of microbiological specimens) to have become ill in August and one hundred and eleven in September. Seventy-nine cases have become ill in October (so far). Between August and October 2005, one hundred and seventy-four cases were reported. The number of cases reported this year is nearly double that for the same period in 2005 (figure 1).

Figure 1 All legionnaires' disease cases with known dates of onset, reported since 1 August (with travel abroad removed)

Two hundred and fifty-five of the 319 cases are male (80%), and the peak age group is between 50 and 59 years. Cases have been reported from all regions but there is no suggestion of a national outbreak occurring. Local clusters continue to be investigated for common sources of infection. Of the 319 cases with known onset between August and October, 53 (20%) are associated with travel abroad and 31 (12%) with travel in the UK. The remaining cases are assumed to be community acquired. Overall, the peak dates for onset of illness, excluding cases linked to travel abroad and those with unknown day of onset, centre around the 25 August and around the 3 October (figure 2).

Figure 2 All legionnaires' disease cases with known dates of onset, reported since 1 August (with travel abroad removed)

Table 1 All cases of legionnaires' disease by region of report and underlying population, in comparison with the rate for 2005

*Based on ONS 2005 population estimates.

Although the absolute number of cases in each region shows considerable variation (from 11 to 52 cases between August and October), the rates are relatively constant when the underlying populations are taken into account (from 0.38 to 1.21 cases per 100,000). The rate in the East Midlands is notably higher than their comparable rate in 2005, while London’s rate has decreased despite the nationwide increase in cases this year.

The HPA Centre for Infections (CfI), through its Respiratory Diseases Department, Respiratory and Systemic Infection Laboratory (RSIL) and Water and Environmental Microbiology Reference Unit (WEMRU) in collaboration with Local and Regional Services, is continuing to monitor the situation. Further cases, updated information on previously reported cases, and reports of cluster investigations should be sent to the Respiratory Diseases Department at CfI. RSIL is undertaking confirmatory testing on all positive urine antigen samples submitted and requests clinical material (for example sputum or other respiratory tract samples) for culture, PCR and epidemiological typing. In addition, WEMRU is available to provide advice and assistance on environmental investigations and control of legionella.

References
1. HPA. National increase in cases of legionnaires’ disease. Commun Dis Rep CDR Wkly [serial online] 2006 [accessed 8 November 2006]; 16(37): news. Available at <http://www.hpa.org.uk/cdr/archives/2006/cdr3706.pdf>.

2. HPA. National increase in cases of legionnaires’ disease - update. Commun Dis Rep CDR Wkly [serial online] 2006 [accessed 8 November 2006]; 16(38): news. Available at <http://www.hpa.org.uk/cdr/archives/2006/cdr3806.pdf>. .

New frontiers – annual report of the National Chlamydia Screening Programme in England 2005/6

The National Chlamydia Screening Programme (NCSP) has recently published its annual report for 2005/6. The findings for the year include that:

• The screening volumes have greatly increased, with nearly 100,000 screens in the third year 2005/6
• 1 in 10 of young men and women tested were positive for chlamydia
• Management and treatment of positive cases, including partner treatment, is undertaken primarily within community settings
• Screening within general practice has potential to be developed
• There is a need to provide equitable services for special and vulnerable groups.

The title, New Frontiers, reflects the changing NHS environment in which the NCSP is developing. Progress has been made during the first two phases of implementation involving 25% of all primary care trusts in England. Screening continues to develop in an increasingly broad range of settings: medical, non-healthcare, NHS, private, and voluntary bodies. The third final phase will oversee the roll out throughout England by April 2007 and marks a new scale of operation for the programme. Supporting this is the introduction of the NCSP regional facilitator team who will act to fast track issues from the front line of services to the policy makers.

The National Chlamydia Screening Programme (NCSP) in England began in April 2003 in ten programme areas with a further 16 joining in April 2004. The rest of England was included from April 2006 to give an estimated 85 programme areas in total. The aims of the programme are to offer opportunistic screening to sexually active men and women under 25 years of age attending healthcare and non-healthcare settings; to improve general sexual health awareness; and to reduce the prevalence and costly sequelae of chlamydial infection in England. The programme is managed nationally through the HPA, having moved from the Department of Health in 2005.

References

1. NCSSG. New frontiers – annual report of the National Chlamydia Screening Programme in England 2005/06. London: HPA, 2006. Available at <http://www.hpa.org.uk/publications/PublicationDisplay.asp?PublicationID=52>.