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Last updated: 15 June 2007, Volume 1, No 24 (PDF file, 151 KB)

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New enhanced surveillance test for pertussis

A new enhanced surveillance test for pertussis has been launched. The test is used to estimate IgG antibody levels in oral fluid directed against Bordetella pertussis pertussis toxin (PT). Since 2002 the HPA has been providing a realtime polymerase chain reaction (PCR) service for infants admitted to hospital (now available for infants aged under 1 year) with suspected pertussis; and sero-diagnosis by detection of raised serum IgG antibodies to pertussis toxin (PT) for patients who have been coughing for two weeks or more [1] . Clinicians who are aware of these methods may still be reluctant to take blood in this patient group, so they may content themselves with notifying the infection but not confirming it by laboratory testing. To address this last group, HPA Centre for Infections Respiratory and Systemic Infection Laboratory is now providing oral fluid testing (for anti-PT IgG) to diagnose those who have been coughing for more than two weeks .

The test is particualarly suitable for the investigation of all notified cases of pertussis which have not already been confirmed by other methods (culture, PCR or serology) by oral fluid methods.

The method of taking the specimen is the same as that used for diagnosis and surveillance of measles, mumps, and rubella (ie, brushing along the gumline with the ORACOL saliva collection device (Malvern Medical Developments Ltd). It is suitable for parents to use at home, and to post to the Centre for Infections Respiratory and Systemic Infection Laboratory. It is, however, essential that all specimens are labelled. Unlabelled specimens will not be processed.

Smooth running of this extension to surveillance will rely on good communication between requesting authorities and the HPA CfI Immunisation Department, to avoid cases already confirmed by other methods being followed up again. HPA CfI will inform Health Protection Units of cases they are aware have already been confirmed by culture, PCR, or serological methods.

For further information about the laboratory methods please contact Norman Fry, HPA Centre for Infections, Respiratory and Systemic Infection Laboratory (tel:020 8327 6776), or see the HPA website at http://www.hpa.org.uk/cfi/rsil/bordetella.htm

For further information about the oral fluid kits (which include a brief laboratory request form) please contact the Immunisation Department on 020 8327 7914. Clinicians will also be asked to complete the enhanced surveillance form as is currently done for cases confirmed by other methods. The information requested for national surveillance matches closely that already collected by HPUs for local purposes.

References

1. Crowcroft NS, Fry NK, Litt DJ, Harrison TG, George RC, Abid M, et al. Whooping cough – better methods of diagnosis are now available. BMJ Rapid Responses [online] 2007 [accessed 21 June 2007]. Available at <http://www.bmj.com/cgi/eletters/334/7592/532#164273>

 

Confirmed measles cases in the United Kingdom – an update

The outbreak of measles in the travelling community that started at the end of March is still on-going [1, 2] and there is evidence of limited spread to the wider community. As of 15 June, 79 cases are known to be linked to the travelling community, 68 in travellers and eleven in contacts of travellers. The majority are from the London (21), South East (11) and East of England (32) regions, although cases have also been reported from five other regions (six from the East Midlands, three from West Midlands, two from South West, three from Yorkshire and Humber, and one from North West). Thirty-four of the travellers were identified as having the same D4 measles strain sequence (MVs/Enfield.GBR/14.07/[D4 ] - EF600554 ). An additional 15 cases have an identical D4 strain, although only nine of these are known to have had contact with travelling communities suggesting the strain is now circulating more widely.

To date, 133 cases of laboratory confirmed measles in England with onset dates from 1 January to 10 June 2007 have been reported to the HPA Centre for Infections. During the same period, three cases have been reported in Scotland; two are imported infections in travellers from a Romanian community, both of whom had a D4 strain identified that is distinctly different from the MVs/Enfield.GBR/14.07/ strain associated with the travelling community cases in England , but similar to the sequences currently being identified in Romania ( MVs/Glasgow.GBR/20/07/[D4] – EF653361. No measles cases have been confirmed in Wales or Northern Ireland.

In addition to the traveller outbreak, there have been several other small clusters in England associated with a healthcare worker, a nursery/primary school setting, and a hospital setting (genotype B3) (see current quarterly measles report). Eight cases are known to have acquired their infection while overseas; four in India (three had D8 strains), and one each in Poland (D8), Holland (D8), Denmark (D4), and Pakistan. A further case, who had a D5 strain identified, had contact with someone who returned from Thailand with clinical measles.

Only six of the 133 cases reported a history of receiving a measles-containing vaccine. Ninety per cent (122) were aged under 20 years (15 aged under one year, including four aged under 7 months; 35 aged 1 to 4 years; 41 aged 5 to 9 years; 19 aged 10 to14 years, and 14 aged 15 to 19 years). The eleven adult cases were aged between 20 and 43 years.

References

1. HPA. Measles outbreak in the traveller community. Health Protection Report [serial online] 2007 [cited 18 June 2007]; 1 (21):News. Available at <http://www.hpa.org.uk/hpr/archives/2007/hpr2107.pdf>.

2. Cohuet S, Morgan O, Bukasa A, Heathcock R, White J, Brown K, et al. Outbreak of measles among Irish Travellers in England, March to May 2007. Eurosurveillance 2007;12(6):E070614.1. Available at<http://www.eurosurveillance.org/ew/2007/070614.asp#1>

New moth causes health problems

The Forestry Commission working with Defra, the Health Protection Agency London, and local authorities have launched a joint plan to try to eradicate from London a recently arrived moth that threatens the United Kingdom's (UK's) oak trees and human health [1]. The oak processionary moth (Thaumetopoea processionea ), native to southern and central Europe, derives its common name from the habit of its catapillars forming long ‘processional' lines, was seen on trees in west and south-west London last summer, and has begun breeding in oak trees in a number of locations there, including Kew Gardens. South West London Health Protection Unit first reported the moth problem in 2006, the first time it had been identified in the UK . It has been identified in Europe for over a decade, with Belgium and the Netherlands having significant problems

The caterpillars are covered in tiny hairs that are sharp and barbed, and contain a toxin that can cause skin and eye irritation and rarely allergic reactions in people. The hairs are shed by the caterpillars and people are mostly exposed when these are blown in the wind from a nearby infested tree. More rarely contact is from handling the caterpillars, which is strongly discouraged. Contact with the toxin most commonly causes intensely itchy skin rashes, but can also cause sore throats, eye problems (conjunctivitis) and less commonly breathing difficulties.

People with a severe reaction, or who have an itching rash of uncertain origin, have been advised to consult their GP or NHS Direct

Further information about the species, including pictures and a tree pest advisory note , is available on Forest Research's website, www.forestresearch.gov.uk/oakprocessionarymoth, and the Forestry Commission's website at www.forestry.gov.uk/planthealth.

References

1. Forestry Commission. Action plan launched to eradicate moth. News release No: 9714 . Edinburgh:Forestry Commission, 2007. Available at
<http://www.forestry.gov.uk/newsrele.nsf/AllByUNID/3F377652F9C256B9802572F70036CD11>.