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Last updated: 2 March 2007, Volume 1, No 9 (PDF file,143 KB)

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New HPA report on scalp ringworm: epidemiology diagnosis and management

The pattern of tinea capitis (scalp ringworm) in the United Kingdom (UK) has changed in the past ten years with a significant rise in the incidence of cases of infection, mainly due to Trichophyton tonsurans [1, 2]. The number of cases of skin infections caused by T. tonsurans diagnosed annually at one South London laboratory has increased by more than 40-fold over this period, the overriding majority of these being infections of the scalp (Dr Susan Howell, personal communication).The main focus of this epidemic has been cities. Infection rates show variations with ethnicity but it is clear that infection can occur in any child irrespective of their ethnic origin.

A new report produced by a working group of the HPA Advisory Committee on Fungal Infection [3] describes the epidemiology and deals with the diagnosis and management of tinea capitis. It is a simple concise evidence-based guide aimed at healthcare workers.

Tinea capitis is an infection caused by dermatophyte fungi mainly found in pre-pubertal children [4]. It is an infection of the skin and hair of the scalp generally characterised by local inflammation and hair loss [5]. Infection can range from the asymptomatic to painful inflamed lesions. The main goals of therapy of tinea capitis are treatment of the patient and prevention of spread to other children [4]. Although there is currently only one approved drug for tinea captitis in the UK (the tablet form of Griseofulvin) this report gives the evidence for a range of possible treatment options for cases, carriers and patients with more severe symptoms such as kerions (inflamed lesions). Advice is given on general management to avoid spread including what to do in schools.

Since the clinical signs can vary widely the authors advise that it is unreliable to depend on clinical diagnosis alone and microbiological confirmation should be sought wherever possible. Details on how to take appropriate samples such as scalp scrapings and brushings for the laboratory as well as tests including screening by fluorescence (Woods Light) are given.

Little is known about the risk factors for spread. The report recommends improved surveillance of this problem, to understand the specific needs of the ethnic minority communities, who have been the main focus of this infection, and to ensure that methods are in place to control outbreaks of this common childhood condition.

References
1. Hay RJ, Clayton YM, De Silva N, Midgley G, Rossor E. Tinea capitis in south-east
London-a new pattern of infection with public health implications. Br J Dermatol 1996;135:955-8.

2. Leeming JG, Elliott TS. The emergence of Trichophyton tonsurans tinea capitis in
Birmingham, UK. Br J Dermatol 1995 133:929-31.

3. Health Protection Agency. Tinea capitis in the United Kingdom: A report on its diagnosis, management and prevention. London: Health Protection Agency, March 2007. Available at <http://www.hpa.org.uk/publications/2007/tinea/tinea_capitis_07.pdf>

4. Elewski B. Tinea capitis: a current perspective. J Am Acad Dermatol 2000; 42 (1):1-20.

5. Hay RJ,Moore M. Mycology . In: Champion RH, Burton JL, Burns DA, Breathnach SM. Editors. Textbook of Dermatology 6th Ed. Oxford : Blackwell Science, 1988. pp 1277-1376

 

Update on investigation of workers involved in the Holton avian flu outbreak

The Health Protection Agency (HPA) has now completed the first stage of the public health follow-up in relation to the outbreak of avian flu on a poultry farm in Holton, Suffolk. The Agency alongside local NHS public health colleagues, the Department for the Environment, Food and Rural Affairs (Defra) and staff from Bernard Matthews has offered antiviral drugs to 480 people, 310 of whom have so far also received seasonal flu vaccination. The local Health Protection Unit is continuing to monitor the situation locally, working together with Defra and staff from Bernard Matthews. As a precautionary measure a small number of workers who are involved in the cleaning and decontamination process are continuing to take antiviral medications.

The Agency has carried out testing on six people who developed flu-like symptoms. Three of these people met the criteria for testing, and three others were tested as a precautionary measure. All six tested negative for avian flu, and received appropriate medical care.

The risk of any workers testing positive for avian flu has been assessed as, and remains, very low as they have followed all the necessary precautions in terms of protective clothing and hygiene measures, and have been offered antiviral drugs. The Agency also concluded that the risk to food processing workers and other personnel working in and around the food processing plant as being very low and as a result they did not require any antiviral treatment.

H5N1 avian flu remains largely a disease of birds. The virus does not transmit easily to humans, as evidenced by the 270 or so confirmed infections worldwide to date, versus the millions of people exposed to poultry everyday in south east Asia. Almost all human H5N1 infections so far have been associated with close contact with dead or dying poultry and in all human cases there has been no evidence of efficient human-to-human transmission.

 

NICE guidance on preventing sexually transmitted infections and reducing unwanted under-18 conceptions

The National Institute for Health and Clinical Excellence (NICE) has published guidance [1,2] aimed at halting the rising numbers of sexually transmitted infections and to prevent unwanted under-18 conceptions – of which the United Kingdom has the highest rates in Europe. The guidance focuses on one-to-one interventions that aim to address the personal factors that influence an individual’s sexual behaviour, in order to reduce the transmission of sexually transmitted infections (STIs) including HIV, and reduce the rate of under-18 conceptions, especially among vulnerable and at-risk groups.

The guidance recommends that:

  • Health professionals should identify individuals at high risk of contracting STIs using their sexual history. Opportunities for risk assessment may arise during consultations on contraception, pregnancy or abortion, and when carrying out a cervical smear test, offering an STI test or providing travel immunisation. Risk assessment could also be carried out during routine care or when a new patient registers.
  • Health professionals should have one-to-one structured discussions with individuals at high risk of STIs (if trained in sexual health), or arrange for these discussions to take place with a trained practitioner. The discussions should be structured on the basis of behaviour change theories.
  • Patients with an STI should be helped to get their partners tested and treated (partner notification), when necessary.
  • Midwives and health visitors should regularly visit vulnerable women aged under 18 who are pregnant or who are already mothers and discuss with them and their partner (where appropriate) how to prevent or get tested for STIs and how to prevent unwanted pregnancies. Where appropriate, young women can be referred to relevant agencies, including services concerned with reintegration into education and work.

References
1. National Institute for Health and Clinical Excellence. Preventing sexually transmitted infections and reducing under 18 conceptions. Guidance. London: National Institute for Health and Clinical Excellence, February 2007. Available at <http://www.nice.org.uk/guidance/PHI3>.

2. National Institute for Health and Clinical Excellence. Preventing sexually transmitted infections and reducing under 18 conceptions. Quick reference guide. London: National Institute for Health and Clinical Excellence, February 2007. Available at <http://www.nice.org.uk/guidance/PHI3>.

CJD reporting and surveillance

Following advice from the Spongiform Encephalopathy Advisory Committee (SEAC) the Chief Medical Officer (CMO) has written to remind neurologists to remain vigilant and to refer unusual neurological cases through the established national arrangements for referral and reporting of suspected cases of human prion disease (CJD) [1]. The letter follows recently reported cases of vCJD following blood transfusion, and the identification of atypical cases of scrapie and BSE in a number of countries.

Reference
1. CJD reporting and surveillance PL/CMO/2007/1. London: Department of Health, 2007. Available at <http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/ProfessionalLetters/ChiefMedical OfficerLetters/ChiefMedicalOfficerLettersArticle/fs/en?CONTENT_ID=4143257&chk=c81R6u>.