• World TB Day: TB anywhere is TB everywhere
  

• National electronic Library of Infection hosts National Knowledge Week on TB
  
  

• Listeria contamination of sandwiches
  
  
• New guidance on health clearance for healthcare workers
  
  
  
  

 

 

 

World TB Day: TB anywhere is TB everywhere

World Tuberculosis (TB) Day 2007 is on 24 March, and has the theme: ‘TB anywhere is TB everywhere’. This highlights the infectious nature of TB and emphasises the collective responsibility that touches everyone, everywhere, to contribute towards the global fight against this curable disease.

The World Health Organization (WHO) has just published the 2007 Global TB control report [1]. In 2005 there were an estimated 8.8 million new TB cases worldwide (136 per 100,000 population) and a total of 1.6 million people died of TB. According to WHO estimates, the global TB epidemic may now be on the threshold of decline, although the situation remains critical in many regions of the world such as sub-Saharan Africa and south-east Asia, so there is no room for complacency. The total number of new cases globally is still rising slowly.

Provisional aggregate data on the number of cases of TB reported in the United Kingdom (UK) in 2006 are now available (table). These early estimates indicate a rise of 2% on the provisional number of cases reported in 2005. During 2005 there was an 11% rise in the final number of cases reported (data excluding Scotland). At this stage, it is too early to tell whether these provisional results indicate a slowing of the overall trend of increase in the number of cases. The final total number of TB cases for 2006 is likely to change from the provisional figures due to the receipt of late reports, de-notifications and the removal of duplicate reports. The final results will also include clinical and microbiological information on cases, including drug susceptibility testing results.

Table Provisional number of TB cases and rates per 100,000 reported in the UK: 2005 to 2006*

	2005		2006
Country	Number of cases	Rate†	Number of cases	Rate†
England	7768	15.4	7942	15.7
Wales	164	5.5	168	5.7
Northern Ireland	76	4.4	61	3.5
Scotland	362	7.1	384	7.5
UK Total	8370	13.9	8555	14.2

* Provisional data as of March 2006 and 2007 respectively, except Scotland , both data as of March 2007. Source: Enhanced Surveillance

† All rates expressed as per 100,000 population, calculated from the Office of National Statistics mid-year population estimates for 2005 (2006 estimates not yet available).

To coincide with World TB Day, the Health Protection Agency has released a newsletter providing a more detailed update on the UK and global TB context [2]. The All-Parliamentary Group on Global Tuberculosis launched its own manifesto for action against TB throughout the world, alongside the WHO global report for 2007 at a meeting in London on the 22 March. Information on this and other events can be obtained from the stop TB partnership website at <http://www.stoptb.org/events/world_tb_day/2007/>.

We would like to acknowledge our colleagues at Health Protection Scotland, The National Public Health Service for Wales, and the Communicable Disease Surveillance Centre Northern Ireland for providing the provisional TB figures.

References
1. Global tuberculosis control: surveillance, planning, financing. WHO report 2007 (WHO/HTM/TB/2007.376). Geneva: World Health Organization, 2007. Available at: <http://www.who.int/tb/en/>.

2. HPA Centre for Infections. Tuberculosis update. London: HPA, March 2007. Available at <http://www.hpa.org.uk/infections/topics_az/tb/pdf/newsletter_2007_march.pdf>.

 

 

 

 

 

National electronic Library of Infection hosts National Knowledge Week on TB

The National electronic Library of Infection (NeLI) <www.neli.org.uk>, along with the National Knowledge Service – TB Pilot , is running its first National Knowledge Week from 26 to 30 March 200, to highlight tuberculosis (TB) and tie in with World TB day on 24 March 2007. A comprehensive collection of peer-reviewed publications will be provided to showcase the best current knowledge and highlight current issues on tuberculosis.

NeLI will link to resources developed for patients, public, and professionals by the National Knowledge Service – TB Pilot . These include information resources for managers and staff in hostels for the homeless, for staff working with asylum seekers, and for staff in prisons. Areas of public or professional uncertainty or concern have also been addressed, such as through the development of information resources for carers who work with children, and for healthcare professionals and the public on TB exposure in pregnancy. All these resources are available at <http://www.hpa.org.uk/tbknowledge/nationalknowledgeserv.htm >. Links to other useful TB resources on the web will also be provided.

The Health Protection Agency supports the National electronic Library of Infection (NeLI) in collaboration with the National Library for Health (NLH). NeLI is one of the specialist libraries of the NLH, a single portal to evidence-based medical knowledge around infection. The core function of NeLI is to provide access to the best available evidence on prevention, treatment and investigation on infection.

NeLI produces a monthly eNewsletter – which is currently subscribed to by more than 1200 professionals. This provides information on the latest news and new resources added to NeLI. To sign up, visit <www.neli.org.uk>.

 

 

 

Listeria contamination of sandwiches

On 27 February 2007, routine testing of a sandwich sampled from a vending machine in Kent on 20 February, revealed high levels of Listeria monocytogenes contamination (160 cfu/g). The vending machine had been operating at 16°C instead of at or below 8°C. The site of manufacture of the sandwich was inspected by local authority environmental health officers on 7 March. Further food and environmental samples were taken and examined by the HPA Collaborating Laboratory, Kent Environmental Microbiology Services. The confirmed results of the subsequent testing were communicated to Kent Health Protection Unit (HPU) on 12 March. They showed significant contamination with L. monocytogenes of sandwiches manufactured on this site (both on day of production and at end of shelf-life) and of the environment. Levels of contamination in tested sandwiches ranged from 10 to 270 cfu/g.

An outbreak control team (OCT) meeting was held the same day involving representatives of Kent HPU, Ashford Borough Council, and Kent Environmental Microbiology Service. The factory immediately ceased production, voluntarily. The Food Standards Agency (FSA) was informed. Customers were informed by the manufacturer and advised to withdraw all sandwiches from sale.

Approximately 10,000 sandwiches were produced by the manufacturer on this site each day (except Saturday); approximately 190,000 sandwiches between 18 February and 12 March. Approximately 40% of sandwich distribution was to hospitals in the South East and London. An uncertain proportion of this distribution was consumed by patients (sandwiches were also sold to staff and visitors). The remaining 60% were distributed to various outlets including schools and commercial organisations in the South East, London, and Essex.

A risk assessment was undertaken by the OCT. Information was sent to affected strategic health authorities, for onward distribution within the NHS, and to HPUs. A joint press release was issued by the FSA and the Health Protection Agency on 16 March alerting particularly those in vulnerable groups (pregnant women, older people and the immunosuppressed) to seek medical attention if they became unwell in the following two to three months [1,2].

To date, no cases of listeriosis associated with consumption of sandwiches produced by this manufacturer have been identified.

L. monocytogenes can cause a variety of diseases. Infections range from a mild flu-like illness to severe disease. Infections in pregnancy may precipitate premature birth or miscarriage. Infections in the neonatal period may present with meningitis. Patients whose immunity to infection is impaired, such as those with haematological or solid organ malignancies and transplant recipients may develop septicaemia or meningitis. The infection can be treated with antibiotics; however, in about one third of cases the disease is fatal. Case fatality ratio varies according to co-morbidity. Clinical symptoms include, fever, myalgia, malaise and backache. Occasionally the disease manifests as a food poisoning with diarrhoea, abdominal pain, nausea and/or vomiting. Severe forms include septicaemia, meningitis and encephalitis.

Clinicians should seek advice from their local microbiologist if they suspect a patient has listeriosis, both for the laboratory diagnosis of listeriosis and for advice on treatment. Clinicians are urged to report such infections to the Consultant in Communicable Disease Control in their local Health Protection Unit. Microbiologists should ensure that isolates are sent to the HPA Centre for Infections (CfI) for further characterisation.

References
1. HPA. Food Standards Agency and Health Protection Agency alerting consumers about sandwiches possibly contaminated with Listeria (Press release). London: HPA, 2007. Available at <http://www.hpa.org.uk/hpa/news/articles/press_releases/2007/070316_listeria.htm>.

2. Food Standards Agency. Consumers alerted to possible listeria in sandwiches (Press release). London: FSA, March 2007. Available at <http://www.food.gov.uk/news/newsarchive/2007/mar/listeria>.

 

 

 

 

 

 

 

 

 

New guidance on health clearance for healthcare workers

The UK Department of Health has recently issued new guidance to the NHS on health clearance for tuberculosis, hepatitis B, hepatitis C, and HIV in new healthcare workers [1]. This guidance relates to healthcare workers new to the NHS, those who are moving to a first post or training that involves exposure-prone procedures (EPP), and returning healthcare workers who may have been exposed to serious communicable diseases whilst away from the health service.

The guidance recommends standard health clearance checks that should be completed on appointment for all new healthcare workers, including checks for tuberculosis disease/immunity, the offer of hepatitis B immunisation and testing of post-immunisation response and the offer of hepatitis C and HIV tests. Additional health clearance checks are required for those healthcare workers who will be performing EPPs, and should be completed prior to confirmation of appointment. The healthcare workers must be non-infectious for HIV (antibody negative), hepatitis B (surface antigen negative or, if positive, e-antigen negative with a viral load of 10³ genome equivalents/ml or less) and hepatitis C (antibody negative or, if positive, negative for hepatitis C RNA).

The new guidance, which is consistent with existing policy, is intended to restrict healthcare workers infected with bloodborne viruses from working in the NHS in clinical areas where their infection may pose a risk to patients in their care. Testing is a one-off and relies on the current obligation for healthcare workers to seek confidential professional advice, if they believe that they may subsequently have been exposed to a serious communicable disease.

In addition, the UK Department of Health has released new guidelines based on recommendations from the Advisory Group on Hepatitis, allowing certain hepatitis B infected healthcare workers to perform EPPs whilst on oral antiviral therapy [2]. Previous guidance, issued in 2000, had restricted
e-antigen negative hepatitis B infected healthcare workers from performing EPPs if their HBV DNA level was greater than 103 genome equivalents/ml (geq/ml). Those with a level at 103 geq/ml were subject to annual HBV DNA level testing with a restriction on EPP practice if their viral load went above that level [3]. However, the new guidance now permits e-antigen negative hepatitis B infected healthcare workers with pre-treatment HBV DNA levels between 10³ and 10⁵ geq/ml to perform EPPs while on oral antiviral therapy if their viral load level is maintained below 103 geq/ml. It is recommended that these healthcare workers should have their HBV DNA levels checked every three months, and should cease to perform EPPs if the level rises above 103 geq/ml on or after treatment, or if they stop treatment for any reason. Due to patient safety concerns, healthcare workers with a baseline viral load of above105 geq/ml will not be allowed to perform EPPs while taking oral antiviral therapy. If a patient is exposed to the blood of an infected healthcare worker, the requirement for post-exposure prophylaxis and other measures should be assessed at a local level.

References
1. Department of Health. Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers. London: Department of Health, 16 March 2007. Available at <http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/
DH_073132>

2. Department of Health. Hepatitis B infected healthcare workers and antiviral therapy. London: Department of Health, 16 March 2007. Available at <http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/
DH_073164>

3. Department of Health. Hepatitis B infected healthcare workers. Health Service Circular HSC 2000/020. London: Department of Health, June 2000. Available at <http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/
dh_4012257.pdf>.